Understanding Sperm Lavage for Intrauterine Insemination (IUI)

In the realm of infertility treatments, Intrauterine Insemination (IUI) accompanied by sperm washing and filtration is a widely used method. It provides a cost-effective, safe, and successful approach for couples seeking to conceive. Here, we explore essential details about the process of sperm washing and the introduction of filtered sperm into the uterus, known as IUI.

1. Sperm Washing: The Cleaning Process

Sperm washing is the meticulous cleansing of sperm, wherein the objective is to select the highest quality sperm for either direct uterine injection or in vitro fertilization. The process involves the following steps:
After extraction from the male donor, the sperm are placed in a specially formulated solution to create a favorable culture environment.

The next stage involves subjecting the sperm to centrifugation, which effectively segregates the healthy sperm from weak, dead, deformed sperm, or sperm potentially containing pathogens and toxins.
Subsequently, the purified, healthy sperm is readied for injection into the uterus or in vitro fertilization. Currently, two prominent sperm washing techniques are concentration gradient and Swim Up.

2. Intrauterine Sperm Injection (IUI): Enhancing Conception

Intrauterine insemination (IUI) is the procedure of introducing thoroughly filtered sperm into the woman's uterus. The primary objective is to amplify the sperm count and reduce the distance the sperm must travel, making it more convenient for the sperm to reach the egg. This enhances the likelihood of successful conception.

3. Indications for Uterine Sperm Injection

In cases of infertility, uterine sperm injection is recommended for the following conditions:

• Mildly compromised sperm quantity or quality, or the presence of anti-sperm antibodies.
• Mild pelvic adhesions.
• Infertility due to cervix abnormalities.
• Unexplained infertility.

It's essential for the female partner to have at least one well-functioning fallopian tube and exhibit ovulation during the treatment cycle for IUI to be considered.

4. Evaluating Filtered Sperm

Parameters used to assess sperm quality before and after washing encompass semen volume, sperm density, forward motility, and the total number of motile sperm. Recent research indicates that a sperm density ranging from 10 million to 20 million, a motile sperm percentage exceeding 30%, and over 5 million motile sperm after washing are indicative of increased chances and success rates for conception.

5. The Procedure of Sperm Injection into the Uterus

The husband typically provides the sperm, either at home or at a hospital, before transporting it to the laboratory for filtration. For optimal sperm quality, it is advisable to obtain the sample at the hospital. If collected at home, it should be delivered to the facility within 60 minutes.

After filtration and selection of viable sperm, they are introduced into the woman's uterus through a slender catheter. The entire procedure of sperm injection into the uterus typically lasts about 3 to 5 minutes.

Afterward, it's recommended for the woman to rest for 15 to 20 minutes to provide the sperm with favorable conditions to reach the egg. Upon returning home, normal activities can be resumed, though strenuous physical labor should be avoided.

6. Sperm Leakage After Injection

Unlike fresh sperm, filtered sperm are concentrated in a small volume, preventing them from escaping the uterus. In some cases, the woman may feel vaginal wetness, which is typically due to the antiseptic saline solution used to clean the vagina and cervix or cervical mucus. This is not a cause for concern.

7. Timing of Sperm Injection into the Uterus

For couples opting for two injections, the recommended timing is 24 hours and 48 hours after the hCG ovulation injection. In cases of a single injection, it should be administered 34 to 40 hours post-hCG injection.

8. Success Rates of Sperm Filtration and Injection Methods

Research indicates that the success rate of sperm injection filtration methods can vary from 6% to 26%, depending on the cause of infertility, sperm quality, and the number of ovarian follicles. Higher sperm quality and greater ovarian follicle numbers correlate with higher chances of successful conception. However, it's important to note that an excessive number of ovarian follicles, beyond 3 to 4, may increase the likelihood of multiple pregnancies.

The health and well-being of both partners significantly impact the effectiveness of sperm washing and injection methods. Couples are encouraged to prepare both physically and emotionally to achieve positive results.

9. Abstaining from Sex Pre and Post Sperm Injection

Before sperm injection, it is recommended to abstain from sexual activity for 3 to 5 days to enhance the quality of the sperm collected for filtration. Following sperm injection into the uterus, normal sexual activity can be resumed.

10. Key Considerations for Sperm Injection Filtration Method

For the female partner, maintaining a nutritious diet rich in proteins, vitamins, and minerals is crucial. Avoiding fast foods, unpasteurized foods, and foods known to induce uterine contractions is advised. Furthermore, folic acid and iron supplementation for at least 1-3 months before the procedure is recommended.

For the male partner, consuming foods beneficial for sperm health, such as those rich in folic acid, zinc, and vitamin C, is advised. Regular exercise, limiting strenuous activities, and avoiding harmful substances, like tobacco and alcohol, are crucial.

In conclusion, sperm washing and intrauterine sperm injection offer a promising solution for couples dealing with infertility. By adhering to specific guidelines and maintaining overall health, couples can enhance their chances of successful conception through this method.