INTRAUTERINE INSEMINATION (IUI)
lUI may be either AIH (artificial insemination husband) or AID (artificial insemination donor). Husband’s semen is commonly used. The purpose of IUI is to bypass the endocervical canal which is abnormal and to place increased concentration of motile sperm as close to the fallopian tubes. The indications are tabulated.
Techniques: Common methods to extract sperm from the seminal plasma are: washing, swim-up and density gradient centrifugation. Swim-up method allows most motile sperm to swim-up into the supernatant. Compared to washing method it contains no dead sperm and cellular debris. About 0.3 ml of washed and concentrated sperm is injected through a flexible polyethylene catheter within the uterine cavity around the time of ovulation. Washing in culture media removes the proteins and prostaglandins from semen that may cause uterine cramps or anaphylactoid reactions.
Density gradient centrifugation recovers most highly motile as well as morphologically normal sperm. The processed motile sperm count for insemination should be at least 1 million. Best results are obtained when the motile sperm count exceeds 10 million. Normal sperm survive in this female reproductive tract and can fertilize an egg for at least 3 days but an oocyte survives only for 12–24 hours. The procedure may be repeated 2–3 times over a period of 2–3 days. To increase sperm motility,
pentoxyphylline (phosphodiesterase inhibitor) has been used. Generally 4–6 cycles of insemination with superovulation is advised.