Intrauterine sperm insemination - IUI

Artificial insemination means the processing of sperm in the laboratory, using complex methods, and its intrauterine insertion. It can be used the partner?s sperm or from a donor.

The artificial insemination advantages are the simplicity pf the technique, low costs and the fact that it can be performed monthly.

Indications :

1. 1. Minor male pathology
2. 2. Cervical cause of infertility
3. 3. Not an obviously cause of infertility (idiopathic)
4. 4. Anovulation

Before beginning the insemination procedures a global preconception evaluation is needed and the fertility evaluation (at least the Hysterosonography HyCoSy, the monitoring of ovulation and spermogram), and in some cases the determination of hormonal profile of both partners is needed.

Medication:

The current tendency is to associate the artificial insemination with superovulation in order to enhance the success chances.

The drugs used are Gonal-F, Puregon, Bravelle and others. Triggering the ovulation is done by the administration of hCG ? chorionic gonadotropin (Pregnyl, Brevactid).

Sperm preparation:

Sperm preparation is meant to select the motile spermatozoa, to separate them from the seminal liquid and other cells (leucocytes, bacteria, non-motile spermatozoa), as well as to activate them in a small quantity of nutrient rich medium.

Simple washing is made by diluting semen sample with a sterile culture medium and centrifuge, followed by the re-suspension in culture medium.

Swim up technique separates the good motile sperm by allowing them to 'swim up' into a layer of sterile culture medium, leaving other cells at the bottom of the recipient. Normally, the percentage of morphologic normal recovered cells is higher.

Density gradient technique provides a good selection, spermatozoa having to cross through different density layers.

In the catheter of insemination is loaded a small quantity of culture medium in which motile spermatozoa have been concentrated.

IUI technique:

It is a simple, unpainful technique which is performed ambulatory. After the special lab preparation, sperm is loaded in a special, very thin and nontraumatic, catheter which will be inserted through the uterine cavity. The procedure of inserting the catheter and injection of the sperm is very fast and unpainfull. No additional measures or restrictions are necessary after the artificial insemination.

Results:

After 5-6 artificial insemination cycles 30-35% couples obtain the pregnancy, after that the success chances do not improve significantly with the number of inseminations and IVF is recommended.

In order to improve the chances of success, and also to help the women that do not spontaneously ovulate, ovulation can be induced or stimulated using drugs. The production of more mature follicles after the stimulation increases the pregnancy chances, but also those of multiple pregnancy.