Θυατείρων 3, Νέα Σμύρνη / 3, Thiatiron Str. 171 21, Nea Smirni

Sperm preparation for
intrauterine insemination (IUI)

When is the IUI recommended?

In cases where the partner/husband cannot place his spermatozoa inside the vagina at the right moment or in case there is no partner/husband (donor IUI).

In the most
effective way

What intrauterine insemination (IUI) is about?

The intrauterine insemination consists in transferring the “fertile” spermatozoa inside the uterus at the time of ovulation. It is distinguished in homologous when it is the sperm of her partner/husband used and heterologous when it is the sperm of a third person (donor) used.

This medical practice is performed only by a gynaecologist.

Although a gynaecologist performs the intrauterine insemination, it is the competence of a biologist to prepare the semen, i.e. to remove the seminal liquid and the “useless” spermatozoa (of bad motility or morphology), and then transfer the “fertile” spermatozoa in a special nutritional solution with which the gynaecologist will put the spermatozoa in the uterus. The seminal liquid does never pass inside the uterus. It serves only in protecting the spermatozoa from the acid ambient of the vagina. When the spermatozoa are transferred directly inside the uterus, the seminal liquid must be removed.

How does the intrauterine insemination helps?

The intrauterine insemination helps in placing the spermatozoa in the uterus at the proper timing. Therefore, it is useful when her partner/husband cannot place his spermatozoa in the vagina at the proper timing or when there is no partner/husband.

IMPORTANT NOTE: The intrauterine insemination helps in the timing of the meeting of the spermatozoa with the egg, provided that the sperm is healthy.

When does the intrauterine insemination NOT help?

There is a misunderstanding in regards to the intrauterine insemination. It is wrongly claimed that this technique can help a “weak” semen to fertilize the egg. In this regard, it is supported that if the spermatozoa are few (oligozoospermia), if a low percentage of them is progressing efficiently (asthenozoospermia), or both (oligoasthenozoospermia), this technique helps them fertilize anyway by transferring them directly inside the uterus, i.e. closer to the egg. In support to this, it is pretended that the sperm preparation for intrauterine insemination enriches, reinforces or invigorates the sperm before its transfer in the uterus. The thruth is proven in the following:

Consider a semen containing 100mill. spermatozoa, of which 20% with progressive movement (type a+b) and 80% immmotile (type d). This semen is wrongly characterized “weak”. This gives the impression that the spermatozoa are weak, while it is the percentage of the spermatozoa moving well that is actually low. After the ejaculation inside the vagina, the 20mill. well progressing spermatozoa could pass inside the uterus and move towards the oocyte to fertilize it. The immotile spermatozoa remain in the vagina and are discarded with the seminal liquid.

The processing of semen in the laboratory simulates the selection performed by the cervix (only the “fertile” spermatozoa are allowed to pass inside the uterus). During this processing of semen (“washing”), the seminal liquid and the “bad” spermatozoa are discarded, while the “good” ones are given to the gynaecologist who tranfers them directly inside the uterus (intrauterine insemination). Obviously, after this processing (or washing), regardless the percentage of the “well progressing” spermatozoa becomes 100%, neither their population is increased nor the spermatozoa become stronger.

When shall you NOT proceed to an intrauterine insemination?

ATTENTION: the intrauterine insemination shall NOT be used as being a method that helps a weak semen to fertilize. If the partner’s/husband’s semen is weak, the intrauterine insemination is just bypassing the real problem. It is indeed the wrong treatment.

A weak semen can be improved. Actually, this is mandatory, since it is important for the couple to make children, but they have to be healthy first. Besides, the IUI or IVF success is by far higher with a healthy sperm.

Quite often, weak semen may be due to an infection, while we have had some (very rare) cases where the cause of the weak semen was a tumour of the testicles. If there is an infection (especially from Ureaplasmas, Mycoplasmas or Chlamydia), the intrauterine insemination or whichever technique of medically assisted reproduction (e.g. IVF) is compromised already by the beginning, since the infection may cause abortion, premature delivery or even serious problems to the embryo. Moreover, if the infection remains untreated, it will compromise his prostate’s health, it will also keep causing recurrent UTIs to the couple. Therefore… (read the next paragraph)

What to consider BEFORE you proceed to an intrauterine insemination?

Before you proceed to an intrauterine insemination (IUI) or IVF, it is necessary that both partners have a complete microbiological exam (especially for Ureaplasmas, Mycoplasmas and Chlamydia). Men shall also have an andro-test and consult an urologist. Furthermore, because of the fact the Ureaplasmas, Mycoplasmas and Chlamydia do not appear with symptoms and they are hardly detected, the best method for detecting them is the PCR. Unfortunately, this method has a high cost. Our laboratory considering the need for detecting the presence of these microbes and in order to help our examinees having an accurate and reliable examination, offers this exam at the lowest cost.

The cause for the low number (oligozoospermia) or motility (asthenozoospermia) of sperm may also be a varicocele, a hormonal disorder or else. Competent to make the diagnosis and recommend the proper treatment to men is only the urologist. With an improved sperm, the chance of having a successful IUI or IVF will be increased, but you may also not need either of these anymore to achieve a pregnancy.

Even in the case the woman is unmarried/single, it is very important to exclude the presence of any hormonal disorder or infection, especially from Ureaplasmas, Mycoplasmas and Chlamydia tr., before the treatment (i.e. intrauterine insemination or in vitro fertilization).

The hormonal disorders may cause hyperstimulation of the ovaries, eclampsia or at least influence the development of the fetus. Some symptoms related to hormonal disorders are: cycle duration over 29days or irregular, the presence of polycystic ovaries, uterine fibroids or endometrioses. The hormonal disorders shall be investigated and treated only by an ENDOCRINOLOGIST.

Is it successful?

Compared to natural intercourse, the chance of getting pregnant is increased, because this method helps in placing the sperm at the right moment. Alternatively, you may follow the ovulation yourself by an ovulation home-test or have it followed by your gynaecologist. When the ovulation is approaching, instead of having an IUI, you may have an intercourse at the comfort and discretion of your personal place.

Regardless of whether you will have an IUI or intercourse, the probability of conception could be increased if the gynaecologist recommends a slight stimulation of the ovaries, in order to help you produce more than one oocyte.

Which is the procedure of an IUI?

The gynaecologist follows by the use of ultrasounds the development of the follicle already by the first week of your cycle and every 2-3 days up to the day of ovulation. Then he performs the IUI, i.e. the transfer of the spermatozoa inside the uterus by using a very thin catheter (tube/straw). The woman stays lied for nearly half an hour until she is allowed to leave. She is also advised to abstain from any intense physical activity, especially on the 3rd and 4th day after the intrauterine insemination, because the implantation of the embryo takes place on those days.

Which is the procedure of the sperm preparation for intrauterine insemination?

The sperm preparation for intrauterine insemination is performed only by a biologist, in an Embryology or Spermatology laboratory.

When you arrive at SPERMLAB, you will be given a form, where you have to fill in your details and answer a few questions about your medical history. At this point, in the case of an homologous IUI, the presence of both partners is mandatory, because both have to sign the informed consent. Follows an interview, where you will be given instructions on the correct collection of the sample and will be able to discuss any questions you may have.

You will collect the sample in a comfortable and discreet room, where you are allowed to enter with your partner. After collection, you come back to the interview room to confirm that there was no loss during collection and to be informed about the time the semen will be ready for the IUI (usually 1 to 1½h later). Until then, you may have a walk around the Acropolis, which is in front of our laboratory.

The sperm preparation for intrauterine insemination consists in selecting the good motility and good morphology spermatozoa, which are then transferred in a special medium that permits their placement inside the uterus. The prepared sample shall be transferred at body temperature to the gynaecologist. It is better if the intrauterine insemination is performed in the next three hours.

If your partner/husband is not available at the time of ovulation, the semen sample may be collected several hours or days earlier. It will be kept properly until it is needed for the IUI. Furthermore, under prior communication with the gynaecologist, it is possible to send the prepared sperm directly at your doctor.

Sperm preparation for intrauterine insemination is possible even outside the laboratory’s working hours or in the weekend and holidays under prior communication with the gynaecologist. For your convenience, it would be better if you let us know that you are planning an IUI, already by the day before.