Dr. Sahar Muhssin Muhammad M.B.Ch.B., D.G.O., Dr.Samira A Muhsin M.B.Ch.B., D.G.O.
Vol. 7, Jan-Jun 2019
Abstract:
Background: Artificial insemination (AI) is a procedure in which sperm are placed in the cervix or high in the uterine cavity through a transcervical catheter. The aim is to deposit sperm as close to the oocyte as possible (ASRM, 2006). It may be preceded by ovarian stimulation with gonadotropins or clomiphene to encourage multiple oocytes development, especially in cases of unexplained infertility (Mathuret al., 2007).Sperm separation procedures are able to significantly improve the sperm quality, such selection of spermatozoa separates motile sperm from nonmotile, removes seminal plasma, and infectious agents, other background materials and debris (Zavos, 1992) and also in the same time initiates the capacitation of sperm (Henkel and Schill, 2003). Patients, materials and methods: One hundred thirty-five infertile couples were participated in this study where the male partners needed in vitro sperm preparation and activation, while the female partners were normal and subjected to ovarian stimulation program. In vitro sperm activation was performed using two different techniques, the centrifugation swim-up technique with Global medium and density gradient technique with ALLGrad solution and Global medium. Randomly the infertile males shared in this study were grouped into two groups according to type of technique used in sperm preparation. In the first group the centrifugation swim-up technique was applied for 70 infertile males, while in the other group 65 infertile males have density gradient technique for their in vitro sperm activation. Both groups were subjected to IUI. Results: Intrauterine insemination was applied for the wives of all infertile males involved in this study after having in vitro preparation for their sperm samples, among the 135 couples involved in the present study, 16 couples have positive IUI outcome, 9 couples were in the group used density gradient technique with percentage of (13.8%) which is higher than the percentage of positive IUI outcome in the infertile couples used centrifugation swim-up method where it was (10%) and count of 7 from 70 patients used that technique. Conclusions: Density gradient techniques with ALLGrad solution has better IUI outcome compared to centrifugation swim-up technique. An improvement of percentages of sperm progressive motility, grade (A) progressive sperm motility, normal sperm morphology that were higher in density gradient technique were the main factors that enhance the IUI outcome.