- Before the procedure, the semen processing media is removed from 2-8°C and is kept on the heating block at 37°C for atleast 20-30 mins so that the temperature of the media and the semen sample is almost the same. After collection, the sample is kept in the laminar flow over the heating block for liquefaction in sterile air with 37*C.( This generally takes 20 minutes).
- The count and motility is then checked under the microscope &a live image is stored where in the couple is informed about the sample (We have special video & snap system).
- The raw semen sample is then taken in a sterile test tube &an equal volume of the sperm preparation medium is added. After thorough mixing, this tube is then placed in the spermifuge for a desired time and speed (depending on the sample).
- After centrifugation, the supernatant is discarded but a small volume is left behind.
- The pelette formed is then gently resuspended in this supernatant.
- The sperm preparation medium is then layered slowly from the side wall of the tube without the pellet being disturbed. At this time, there are 2 clearly distinct layers formed, the top being of the medium and the lower layer being the resuspended pellet. The tube is then incubated in the heating block at 37°C for 45-60 minutes.
- Post incubation, the top most layer now containing the active sperms is aspirated for insemination &the post wash count is checked.
- Both, the pre-wash and post wash count are checked and the image/video of the same are shown to the couple along with a detailed report of the same.
- The required consent form is signed and we then proceed for insemination.
- The female partner is then made to lie down on the bed and with her legs parted.
- An instrument called speculum is inserted in the vagina to see the cervix. The vagina is then cleaned with sterile gauze piece to remove the debris and discharge.
- A thin tube called the IUI catheter is introduced in the uterus via the cervix (The lower part of the uterus) and the washed semen sample is slowly released in the uterus.
- Then the female partner has to lie down on the bed for 15-20min.
IUI : Media
Medium should maintain sperm integrity, and promote acrosome reaction and capacitation.
Commonly used media are as follows:
- Bicarbonate buffer media, equilibrated with 5% carbon dioxide, 5% Oxygen and 90%Nitrogen at 37ºC with 95% humidity for 8 days.
- 10% heat inactivated serum or HAS or synthetic serum can be added as protein supplement.
- Additions of methyxanthene derivatives like pentoxyphylline & caffeine can be added.
It is a tabletop centrifuge with a temperature controlled chamber specially made for semen sample preparation. It is intended to be used in Andrology (preparation in IUI and IVF labs). It has a graphic LCD display and a dial encoder. The function of a temperature controlled chamber makes this equipment unique the lab. The entire emphasis is to maintain the specimen temperature at 37 *C (to keep the temperature as close to body temperature) and to eliminate any thermal shocks. This advantage prevents any kind of damage to the sperms, thus maintain the quality and motility of the sperms to produce very good result.
Laminar air flow
The laminar air flow is capable of maintaining a sterile work area even when operated even in an uncontrolled environment. This is achieved by the total removal of the airborne droplet nuclei & dust – borne bacteria uni- directional oriented streamlines of clean air at velocities designed to flush the contaminating particles. This also creates a sterile pressure against the intrusion of external contaminants, & sweeps out particulates produced by the work process not allowing them to deviate, let alone settle down. It is used in IUI lab for air flow that air flow passed throw hepa filter. The air flow passed through hepa filter is clear of dust, microorganisms and thus transferring only the sterile air in which we can perform processing.
The microscope is attached with LCD,to show the prewash &postwash semen count to the couple.
- This is used for warming the test tube, sample & medium to maintain the temperature as close as possible to body temperature.
What is Intrauterine Insemination Catheter?
Various types of catheter have been used for IUI. These are known as IUI catheters. They are easy to use. They were semi-rigid devices that fit the curvature of the uterus & minimize trauma to the cervical crypts, endometrium and uterine walls. They are made of non-toxic material. They carry a small volume from their intrauterine tips with minimal dead space (to minimize backflow). Care is taken so that the tip of the catheter does not touch the fundus of the uterus as it may cause contractions.
Instruments used for IUI :
A well timed IUI is the critical key to success of the procedure.
After documenting ovulation, the husband has to give semen sample for IUI. This semen sample is then processed. The processed and washed semen is used for insemination.
The patient is told to lie comfortably in supine position with flexion at her hips. The mouth of uterus (Cervix ) is visualized with the help of a speculum (instrument). Irrigate the ectocervix and endocervix with buffer. Place the catheter fully assembled, negotiate the internal os gently and deliver it 1.5-2 cm from the internal os. The semen sample is then injected slowly into the uterine cavity with the help of IUI catheter over period of 1-2 mins. Remove the catheter slowly after 30 seconds.
After the insemination, the woman is told to remain in the dorsal position for around 10 -15 minutes.
There is no need of prolonged bed rest, head low, pain killers, antispasmodics or antibiotics.
Studies have shown that catheterizing distance of 2 cm from the fundus with infused semen volume of 0.3 ml can significantly improve pregnancy rate in patients undergoing IUI with the husband’s semen.
Ankoor clinic recommendations:
- There is no restriction on any kind of diet.
- There is no restriction on traveling, exercise, climbing stairs, swimming etc.
- Intercourse after IUI in fact has shown better pregnancy rates.