Intrauterine insemination

(IUI - artificial insemination AI) of your partner's sperm has a place when there is:-

  •  mildly reduced male fertility, as recognised from semen analysis. Even when there is moderate male subfertility, treatment using ovulation induction and IUI would seem to be a valuable initial treatment before contemplating more expensive and invasive assisted reproductive techniques. Severe male factor infertility does not usually respond to IUI.
  •  unexplained infertility.

At one time, untreated semen was used but adverse reactions sometimes occurred. These days, sperm for insemination are prepared by washing or swim-up to improve success rates and reduce possible complications. The swim-up preparation involves washing the sperm with culture medium, and, after centrifugation (controlled rapid spinning), the supernatant (fluid) is removed. The pellet of sperm is covered by 0.5ml of culture media. In the swim-up preparation, the sperm in the pellet are incubated at body temperature for 30-60 minutes. The supernatant subsequently carries a relatively high concentration of motile sperm and this is used for the insemination procedure. A variety of swim-up techniques and media such as Percoll have been used in an attempt to improve success rates.

Clearly artificial insemination should be undertaken around the time of ovulation. The relationship between the day of insemination in relation to the last day of hypothermia (low temperature) on the basal temperature chart and conception rates in a donor insemination protocol has been studied. The over-all conception rate was 12% and the best results were obtained for insemination 3 days (20%) and 1 day (21%) before the last day preceding the temperature rise that is typical following egg release. LH predictor tests can be used to indicate the fertile phase for a woman with irregular cycles, perhaps increasing the success rate. Success rates with artificial insemination depends on the age of the female partner and the total motile sperm count.

Artificial insemination with donor sperm (AID) has been the most successful treatment for male factor infertility although, not withstanding economic considerations, more modern treatments with IVF and ICSI (25) have an increasing role to play. Success rates in donor insemination programmes of 70% over six cycles have been reported. Frozen samples are now recommended to allow adequate testing of donors for HIV although fresh donor samples have achieved pregnancy rates of 19% per cycle compared to frozen samples giving 5 ?10 % per cycle.


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