Friday, 13 January 2017

How to insert sperm artificially into uterus?

This method involves the collection of semen usually by mastrubation, and separation of the active sperms and its transfer into the uterine cavity of the female partner within 2 hours, by an Intra uterine cannula.

Insemination with the husband’s sperms can be done when the husband suffers from some anatomical  defect like hypospadiasis or from impotency. Artificial insemination from a donor can be done when the husband is totally sterile. This is a highly confidential process and the required consent forms have to be signed.

Intra uterine insemination is a method where the fertility potential of a given sperm sample is enhanced. Here the motile sperms are isolated from the abnormal morphological forms, cellular debris and dead cells.

Common indications for Intra Uterine Insemination:

1. Narrowing of the mouth of the uterus and poor quality of cervical mucus;
2. Presence of Antisperm antibodies in the serum of the male and female;
3. Any surgery performed at the mouth of the uterus;
4. Poor  quality of sperms- decreased count and motility;
5. Ejaculatory disturbances like premature ejaculation or reverse ejaculation;
6. Anatomical disorder of the organ or impotency on the part of the male.
7. Unexplained long standing infertility.

In our hospital, the Intra uterine insemination is done with a specially prepared culture medium called T6 which is made with imported chemicals. The pre-prepared sperms are than doposited into the uterine cavity with a specialised intra uterine cannula from Santa Ana, USA.

The following points may be observed before Intra uterine Insemination:

1. The couple should abstain from intercourse atleast 3 days before the stipulated date for IUI;
2. The semen sample should be collected under aseptic conditions;
3. It is imperative that the genitalia is washed before collection of semen sample for IUI;
4. The sample should be collected in a sterile container;
5. In case of difficulty in collection, the sample should be collected earlier and frozen so that the timing of the IUI is not disturbed;
6. In cases where the count and motility of the sperm sample is low, split ejaculate, i.e. collection of the sperm sample into two parts is beneficial so that the first part of the collection containing the maximum number of sperms may be processed for the IUI.
7. Any patient who has difficulty in collection at the place of the IUI, may collect the sample at home following the same aseptic conditions, but the sample should reach the laboratory within 30-40 minutes of collection, under warm conditions.
8. Patients who have difficulty in collection by masturbation may be given a semen collection device (SCD) and allowed natural coitus.

The sample collected is allowed to liquify at room temperature for 30 minutes after which it is taken in 5 ml plastic tube, to which equal amount of the culture medium is added and spun at 1000 rotation per minute, for 10 minutes. The Supernatent is then pipetted out and fresh culture medium is added and the procedure repeated. The 0.5 ml of the culture medium is overlaid on the sperm pellet and incubated in the CO2 incubator for 45 minutes, after which the motile sperms which swim up to the top of the tube is taken in an intrauterine cannula and introduced into the uterine cavity. Specialized techniques are used for cases of Invitro Fertilization and for sample with low count and motility.

Side effects are very rarely observed after the patient undergoes IUI. For example, the patient may have slight lower abdominal pain which is caused because of the introduction of foreign material into the uterine cavity, thus causing a cramp like feeling. Sometimes mild spotting may occur because of the introduction of the catheter into the mouth of the uterus, which invariably gets arreated in due course without any treatment. 0.2% of cases may be affected by infection because the cervix always harbours bacteria and during the procedure, infection may be carried up.

We prefer to allow natural coitus after IUI only to favour follicle rupture and release of the oocyte. The prostaglandin in the seminal plasma causes uterine spasm creating a vacuum in the uterus, in the process helping the fimbrial end of the fallopian tube to suck in the oocyte.

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