semen preparation for iui dr aruna saxena md(obs& gynae),artce (nus, singapore) director,lifecare...

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Slide 2 SEMEN PREPARATION for IUI Dr Aruna Saxena MD(Obs& Gynae),ARTCE (NUS, Singapore) Director,Lifecare IVF Pvt Ltd Slide 3 SEMEN PREPARATION-Why ? Washing removes seminal plasma (prostaglandins).Prolonged exposure to seminal plasma inhibits capacitation of sperm Dead sperm and pus cells produce harmful ROS (Reactive oxygen species) Selects for motile sperm. Slide 4 SEMEN COLLECTION AND DELIVERY WHO recommendation 3-5 days of abstinence Masturbation Clean wide mouth sterile container Labeling First portion of ejaculate should not be lost Collection in non spermicidal condom following intercourse Slide 5 Normal values for WHO manuals (editions 2-5) 4 Slide 6 Which technique ? GOOD : Parameters normal /> normal BAD : Parameters less than normal UGLY : Parameters severely low, viscous, infected, agglutination NO SPERMS : high speed centrifugation VERY LOW COUNT : Pooling of samples Slide 7 PELLET - SWIM UP Slide 8 Slide 9 Pellet Semen 45% gradient 90% gradient Media Spin Density gradient Slide 10 Media Semen Underlay Migration Slide 11 INSTRUCTIONS TO BE FOLLOWED WHILE HANDLING SEMEN SAMPLE Clean sterile work area (Laminar air flow) Non-toxic, non-powdered gloves Slow Dilution Pre warm media and disposables Preparation performed at 37`c Thorough identification protocol Damage to the sperm from dilution, temperature change.centrifugation,and exposure to potentially toxic material must be minimised Slide 12 Slide 13 Semen prparation techniques for intrauterine insmination (Review ) Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C The Cochrane Library 2009, Issue 1 Five RCTs, including 262 couples in total, were included in the meta-analysis No trials reported the primary outcome of live birth. There was no evidence of a difference between pregnancy rates (PR) for swim-up versus a gradient or wash and centrifugation technique, Nor in the multiple PR in two studies comparing a gradient technique versus wash and centrifugation. There was no evidence of a difference in the miscarriage rate in two studies comparing swim-up versus a gradient technique. 12 Slide 14 Authors conclusions There is insufficient evidence to recommend any specific preparation technique. Large high quality randomised controlled trials, comparing the effectiveness of a gradient and/ or a swim-up and/ or wash and centrifugation technique on clinical outcome are lacking. Further randomized trials are warranted. 13 Slide 15 IN HOUSE IUI FACILITY FOR BEST RESULTS Slide 16 Your Questions are Welcome