1. SEMEN PREPARATION for IUI
Dr Aruna Saxena
MD(Obs& Gynae),ARTCE (NUS, Singapore)
Director ,Lifecare IVF Pvt Ltd

2. SEMEN PREPARATION-Why ?
Washing removes seminal plasma (prostaglandins) .Prolonged exposure to seminal plasma inhibits capacitation of sperm
Dead sperm and pus cells produce harmful ROS (Reactive oxygen species)
Selects for motile sperm.

3. SEMEN COLLECTION AND DELIVERY WHO recommendation
3-5 days of abstinence
Masturbation
Clean wide mouth sterile container
Labeling
First portion of ejaculate should not be lost
Collection in non spermicidal condom following intercourse

4. Normal values for WHO manuals (editions 2-5)4

5. Which technique ?
GOOD : Parameters normal /> normal BAD : Parameters less than normal UGLY : Parameters severely low, viscous , infected , agglutination NO SPERMS : high speed centrifugation VERY LOW COUNT : Pooling of samples

6. PELLET - SWIM UP

7. PELLET - SWIM UP

8. Density gradient
Pellet
Semen
45% gradient
90% gradient
Media
Spin

9. Migration
Media
Semen
Underlay

10. INSTRUCTIONS TO BE FOLLOWED WHILE HANDLING SEMEN SAMPLE
Clean sterile work area (Laminar air flow)
Non-toxic, non-powdered gloves
Slow Dilution
Pre warm media and disposables
Preparation performed at 37`c
Thorough identification protocol
Damage to the sperm from dilution, temperature change.centrifugation,and exposure to potentially toxic material must be minimised

12. Semen préparation techniques for intrauterine insémination (Review) Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C The Cochrane Library 2009, Issue 1
Five RCTs, including 262 couples in total, were included in the meta-analysis
No trials reported the primary outcome of live birth.
There was no evidence of a difference between pregnancy rates (PR) for swim-up versus a gradient or wash and centrifugation technique,
Nor in the multiple PR in two studies comparing a gradient technique versus wash and centrifugation.
There was no evidence of a difference in the miscarriage rate in two studies comparing swim-up versus a gradient technique.

13. Authors’ conclusions
There is insufficient evidence to recommend any specific preparation technique.
Large high quality randomised controlled trials, comparing the effectiveness of a gradient and/ or a swim-up and/ or wash and centrifugation technique on clinical outcome are lacking.
Further randomized trials are warranted.

14. IN HOUSE IUI FACILITY FOR BEST RESULTS

15. Your Questions are Welcome