Make IUI Safe & More Productive

We opted the topic “Make IUI safe & more productive, because  IUI is performed much frequently than IVF.  There is no clear data regarding the ratio of IUI  &  IVF.  But there is estimation that 16.4  IUI is performed  per IVF.  There are two distinct reason behind  this high ratio —

  1. Easy to perform.

  2. Cost effective

Under the heading “Make IUI Safe & More Productive”  our aim is to discuss and point out small small  measures.  Which will the improve the success rate of IUI to a good magnitude.

Insemination is often abbreviated to IUI, – intrauterine insemination.                                                            H.S.A.  —  Human Serum Albumin.

IUI is mainly performed either by Prepared Sperm of Husband / male partner (IUI-H) or  Frozen Sperm of Donor (IUI-D).  Certainly quality of sperm is a big factor. But in our discussion  it is beyond our scope to discuss  how to improve the quality of sperm within the human body.

Other than quality of sperm / semen  there are certain factors and measures. Which influence the outcome of IUI directly.  Since IUI is  either in  IUI-H  or IUI-D form. Therefore our discussion will be under two heading.

IUI-H  — Intra Uterine Insemination – By  Husband Sperm

In this method husband deposit the semen in a sterile container.  Followed by separation of sperm  from seminal fluid.  Finally healthy sperms are re-dispersed id  a uterine friendly medium (HTF  Type) followed by insemination.

Below mentions steps / measures make IUI-H  safe & more productive.

    1. Proper medical examination, investigation & management of both partner.

    2. Psychological assessment & counseling of both partner.

    3. Abstinence – 2 to 5 days.

    4. Semen collection in morning hour.

    5. Maintenance of  temperature of waiting lobby and collection room and laboratory at 25 degree C  (+ /- 2).

    6. Set the temperature of incubator at 32 – 34 degree C (not 37 degree C).  Here it is worth to mention that inside human body formation, development, maturation & storage of sperm occur at 3 to 4 degree C less temperature than core body temperature (37 degree C).    Therefore it is better to prepare the sperm at 33 degree C.

    7. Therefore sperm preparation should be done at a temperature  (32 to 34 degree C) only.

    8. Start the sperm separation from seminal fluid as soon as possible  after liquefaction.

    9. Select a proper sperm wash media.  Preferably separate & re-disperse the sperm in a protein (H.S.A.) free medium.  H.S.A. is having antigenic property.  Moreover any foreign protein is not normal for uterine environment.

    10. Using  Sperm Preparation  Medium with H.S.A.  or any  animal / avian may  be responsible to transmit certain disease  (including unidentified & emerging viruses).  Therefore always avoid  sperm preparation media with H.S.A.

    11. Scan (Ultrasonically) the follicle to determine right time for insemination. Two insemination per cycle give better result than one insemination.

    12.  Inseminate immediately.

    13. Keep the patient on O.T. table for 15 minutes following IUI.

In certain instance clinician need to preserve husband sperm (freezing of husband sperm).   In those specific situation the steps of  IUI – H and  IUI-D  both are equally important.

IUI-D  — Intra Uterine Insemination – By Donor Sperm

Donor sperm are at particular risk of transmitting infection.  Therefore proper screening of donors & quarantine is of prime importance in case of IUI-D.

  1. Proper screening & retesting of donors.

  2. Proper method of sperm freezing .

  3. Use proper cryo-preservative medium for sperm freezing. Cryo-preservative medium for sperm with H.S.A. may decrease success rate. As any foreign protein  in the uterine cavity may be antigenic for uterine environment as well as sperm.  Therefore H.S.A. or any animal or avian based cryo-preservative media should be avoided.

  4. Using cryo-preservative medium with H.S.A.  or any  animal / avian may  be responsible to transmit certain disease  (including unidentified & emerging viruses).  Therefore always avoid  sperm cryo-preservative media with H.S.A.
  5. Avoid taking out Frozen Semen Sample from Liquid nitrogen for sorting or choosing any  special donor’s sample.

  6. Do not keep frozen embryo and Frozen Semen Sample in same cryocan. Keep the Frozen Semen Sample in a separate cryocan.

  7. Proper training of the person handling the Frozen Semen Sample & Liquid nitrogen.                   In developing country  usually cryocans and Frozen Semen Sample are being handled by a para-medical staff.  Who may not have proper training & expertise.

  8. Clinician and para-medical staff  must be aware that cryo-preservation of sperm effect the morphology of sperm up to  35 %.

  9. Regular supervision of liquid nitrogen in liquid nitrogen container.

  10. Proper medical examination, investigation & management of both partner.

  11. Psychological assessment, counseling and preparation of both partner.

  12. Thaw the Frozen Semen Sample at 32 to 34 degree C. (Not at 37 degree C)

  13. Scan (Ultrasonically) the follicle to determine right time for insemination. Two insemination per cycle give better result than one insemination.

  14. Keep the patient on O.T. table for 15 minutes after IUI.

                                                   ——————–  XXX  ——————-

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