Infertility is sometimes associated with poor postcoital testing. This may result from either a problem with sperm production or a hostile cervical mucus environment. The semen specimen may be low in volume, low in the number of sperm, or low in the percentage of motile sperm. The sperm may have an abnormality in the quality of movement or may be abnormally shaped, either of which may interfere with the fertilizing ability of sperm. The male may produce antisperm antibodies which cause sperm to clump together hence interfering with the ability of sperm to fertilize an egg. The cervical mucus may be inhibitive to sperm viability because of the presence of bacteria such as Chlamydia and Ureaplasma. The mucus might also contain antisperm antibodies which would immobilize sperm, and also inhibit the sperm’s ability to fertilize an egg.

In addition, there may be times when adequate contact between the sperm and cervical mucus is interfered with because of certain anatomic problems. There are also situations of unexplained infertility where a definitive cause for the lack of pregnancy cannot be determined despite very careful infertility testing.

It is for some of these above stated reasons that sperm processing and intrauterine insemination (IUI) is carried out. The processed semen sample is directly deposited into the uterine cavity bypassing the cervix. The sperm are, therefore, placed in close proximity to the opening of the Fallopian tubes into the uterus thus significantly shortening the distance that the sperm must travel in order to reach a receptive egg near the end of the Fallopian tubes.

Sperm processing is a laboratory technique in which the sperm cells are separated from the seminal fluid by gentle centrifugation. The sperm are then resuspended in a special nutrient solution.

Centrifugation is again performed to “wash” the sperm. This washing is carried out several times before the sperm are finally suspended in a small volume of nutrient media. This process takes 45-90 minutes to perform depending upon the viscosity of the semen specimen.

The intrauterine insemination (IUI) is carried out in a sterile fashion with the patient in stirrups. The cervix is wiped clean. Several methods are then utilized to place the sperm within the uterus. The primary method utilized a Makler device, which is held in place in the uterus following the injection of washed sperm into the uterus. This device is then removed in 10 to 15 minutes. An alternate method involves the use of a thin catheter may be placed high into the uterine cavity and the washed sperm gently injected and the catheter removed. Either way, the patient is kept in the pelvic position for 10 to 15 minutes following the sperm placement in the uterus.

Occasionally, a different sperm processing is carried out which involves a much longer preparation time. This “swim-up” technique requires that the semen specimen sit in an appropriate incubator environment for up to three hours during the washing phase. This allows the recruiting of only very motile sperm for the insemination.

If the male has antisperm antibodies present in the semen, then he will be required to produce his semen his semen specimen at the office. The semen will then be processed using the chymotrypsin and galactose processing technique. This technique helps to block the negative effects of the antisperm antibodies by chemically separating the antibody bound up sperm.

Instructions

• Please call the office with the onset of the menstrual flow. This is to be done Monday through Friday form 8:15 a.m. to 3:30 p.m. at (610) 374-2214.
• The timing of IUI is usually with urine LH testing. The IUI is done 36 to 40 hours after the LH surge. If an LH surge has not occurred by Thursday evening, please report to the office on Friday morning before 9:15 a.m. for blood work.
• Sometimes IUI is carried out following an ultrasound timed HCG injection. In this case the insemination is performed 38 hours after the injection was given.
• Present the labeled semen specimen to the laboratory for processing. Facilities are available at the laboratory to produce the semen specimen if desired. The semen should be as fresh as possible and certainly no older than one hour from the time of collection. The specimen must be kept warm during transport, such as inside your coat. Refrain from ejaculation beginning about 48 hours prior to anticipated ovulation.
• Rarely, following the insemination, there may be uterine cramping. Very unlikely would be the occurrence of a fever. Report anything unusual to the office immediately.