'The effect of interval from semen collection to IUI, does it matter’

Dr. Neelam Ohri

Varanasi-India

Evaluation of Efficacy

* IUI is widely practiced.

* Main endpoint for evaluation of efficacy is pregnancy rates/cycle

Success rate

• 10 – 16% pregnancy rate/cycle,

• The variation in rate is very high.

Variables for success* The variables are - Different age groups- Cause of infertility,- Treatment Protocol factors:

- The nature of induction of ovulation

- The capacity of processing the semen in the laboratory.

- Insemination techniques involved in different studies.

Time Factor effecting sperm quality

Factors having an impact on results.

1. The place of semen collection i.e. clinic vs. home.

2. Time interval between semen collection and sperm wash and

3. Sperm wash and insemination4. Total time from Collection to

Insemination.

Place of collection

• WHO recommends that ideally the male partner produces the semen specimen in a private room near the laboratory.

• To better assess liquefaction of the ejaculate and prevent its exposure to extremes of temp.

- progressive sperm motility of a freshly ejaculated semen specimen declines

- with time- exposure to extremes of temp.

WHO recommended limit of interval of one hr. maximum from semen collection to its delivery to the lab relates to ‘diagnostic semen analysis’ only.

Should not be applied to ‘therapeutic semen processing’ for clinical procedures such as IUI and IVF.

Time Interval in Collection & SW

Sample collection at clinic or home, which?Fertil Steril 2014

Home vs. Clinic

Some studies seem to suggest that the method of ovulation induction used may influence the

importance of this place of collection

(Yavas et al. 2004)

Factors affecting fertilizing ability of spermatozoa

A. Exposed to prolonged post ejaculation seminal environment. (coll. to s.wash interval)

B. Washed and capacitated motile spermatozoa. (s.wash to IUI interval)

A. Spermatozoa exposed to prolonged post ejaculation seminal environment

1. May result in irreversible prevention of capacitation and hence of acrosome reaction, since seminal plasma contains decapacitation factor(s)

2. Prolonged exposure to ROS (free radicals):- Seminal leukocytes.- Immature and / or abnormal

spermatozoa with residual cytoplasm.

Spermatozoa exposed to prolonged post ejaculation seminal

environmentRELATIONSHIP BETWEEN THE TIME INTERVAL FROM SEMENCOLLECTION TO SPERM WASH AND IUI OUTCOME.

CONCLUSIONS: The time interval from semen collection to sperm wash has no influence to IUI outcome. It seems that the location of semen collection (home vs. clinic) for IUI do not affect pregnancy rates.

Shimizu et al fert Steril2009;92(3):S145

Spermatozoa exposed to prolonged post ejaculation seminal environment

Time intervals for pregnant and non-pregnant patients

Time intervals in min. Pregnant N=30

Non-pregnant N=100

p=Value

Collection to sperm wash (range)

25 (95-35) 28.6 (6-50) 0.335

Sperm wash to IUI (range)

49.2 (5-150) 45.2 (10-105) 0.322

Total time (range) 131.5 (75-300)

135 (45-250) 0.575

In year 2001 – 2002 studied the effect of time intervals between Semen collection, processing and IUI on pregnancy outcomes of 210 CC – IUI cycles.

They concluded that differences in time intervals from semen collection to sperm processing and sperm processing to IUI do not influence pregnancy outcome for CC – IUI cycles.

-Alexander et al Fertil Steril 2005;84:S279

Semen collection to start of sperm wash.

Semen processed within 30 mts. Resulted in a higher preg. Rate than s processed 31-60 mts or more than 60 mts. After collection in HMG treated women.

Yavas et al

(A) Spermotozoa for clinical procedures such as IVF, GIFT or IUI and for the laboratory test of sperms fertilizing ability, must be separated from the seminal environment as soon as possible after ejaculation. Mortimer et al. Human Reprod 1998;13:2139-2146

Washed motile spermatozoa.

May occur if SW–IUI interval is prolonged because seminal decapacitation factors are removed with seminal plasma.

Capacitation occurs spontaneously in simple defined medium indicating a potential role of autocrine induction.

A. Premature capacitation

-Wu C et al.J Biol Chem 2001:276

-Mortimer et al. Human Reprod 1998;13:2139-2146

Washed motile spermatozoa.

A. Premature capacitation (Cont.)

2. Thus, washed motile spermatozoa that have gone into capacitation prematurely, during a prolonged SW-IUI interval might not be able to undergo subsequent changes in the female reproductive tract after IUI.

may occur in sperm washing medium by the motile spermatozoa during a prolonged SW-IUI interval because sperm motility requires energy source such as glucose & fructose.

B. Exhaustion of energy sources

-Williams AC, Ford WC J Androl 2001:22:680-695

Intervals were much shorter in pregnant than in nonpreg HMG

treated women.

Study showed that if washing sperm can be incubated maximum 30 minute at 37 C the pregnancy rate is optimum. The longer period upto 180 minute doesn’t compromise the pregnancy rate.

Study demonstrated that sperm parameters are negatively affected from prolonged incubation time. A maximum 60-minute limit of the interval between the onset of the postwash sperm incubation and IUI time increase pregnancy rates.

(J Turk Ger Gynecol Assoc 2014; 15: 82-5)

Human sperm incubation at room temp, does not allow capacitation. This blocking effect is over come when spermatozoa are exposed to 37 ̊C

Fertil Steril 2002:77:252-9

Study indicates a significantly better and longer preservation of sperm quality when incubation is performed at RT. These findings may convince laboratories to change the routinely used sperm storage conditions in order to maximize the quality of the prepared sperm sample.

Conclusion

Debate goes on…..We need more prospective randomized trialsTo maximize the IUI pregnancy outcome not only should semen specimens be:- collected at clinic and to assess liquefaction,

documentation, - processed as soon as just after liquefaction and

within 30 mts. of collection, but also - IUI should be performed as soon as within 90 mts.

of semen collection.

collection to s. wash 30 mts

Sample collection at clinic

S. Wash to IUI 60 mts Collection to

IUI 90 mts

Preferred Time Interval