Sperm Preparation for Artificial Insemination

Abstract

Intrauterine insemination (IUI) is a common treatment for couples with infertility issues. In order to operate a good IUI program, several elements are necessary. This chapter attempts to provide a comprehensive description of these elements including: aspects of patient education, communication between the laboratory and the referring physician, employee training, safety, sample identification, and documentation procedures. It also describes supplies and reagents needed for IUI, multiple techniques for the preparation of sperm, and advantages of the different preparations. A discussion of special considerations such as the use of positive samples for infectious disease, use of sex-selected sperm, and chemical motility enhancement is included. Keywords IntroductionDue to increased social acceptance and the successful range of infertility therapies now available, more people than ever are seeking treatment for infertility. A broad range of conditions, affecting both the male and female, contribute to infertility. Many circumstances, such as severe oligozoospermia or blocked fallopian tubes, are immediate indications that more aggressive therapies, such as in vitro fertilization (IVF), are needed to be pursued for a reasonable chance of success. However, the majority of patients with less severe or unexplained forms of infertility have a reasonable chance of success with less invasive intrauterine insemination (IUI). While the decision of which infertility therapy to pursue depends on a number of factors including infertile pathologies, age, and finances, for many couples IUI will be the first and only therapy needed.Several factors can contribute to the success rates of IUI, including sperm quality, insemination timing and number of inseminations, age, and the use of ovarian stimulation [1][2][3]. One of the major male factors influencing the rates is the concentration of motile sperm in the prepared sample used for insemination, with pregnancy rates falling off quickly when less than 5 million motile sperm are inseminated [4,5]. Normal sperm morphology has also been evaluated, though the correlation with pregnancy rates is less clear. On average, the pregnancy rate per IUI cycle is about 10-15% when motile sperm are available, though higher rates have been reported, especially when combined with the use of gonadotropins [6].Under normal circumstances, sperm must pass through the cervical mucus to reach the uterus, a process that limits uterine entrance to only the healthiest sperm and prevents dead sperm, debris, and seminal fluid from getting in. Due to the presence of prostaglandins and microbes in the seminal fluid, semen cannot be placed directly into the uterus without the potential of inducing painful cramping and infection. With the advent of sperm preparation techniques to remove seminal fluids, nonmotile cells, and debris, sperm can be placed directly into the uterus with minimal risk. In instances where sperm quality is less than optimal or adverse mucus or cervical conditions exist, IUI can b...