Testing & Diagnosing Infertility Continued

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Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a process that includes collection of semen, washing away the fluids surrounding the sperm, concentrating the sperm into a small amount of media and placing the sperm through the cervix into the uterus. The sperm washing procedure can take 1 – 2 hours depending on the technique utilized. The actual insemination procedure for the woman is relatively quick and painless and feels similar to having a pap smear. The sperm is placed into the uterus past the cervix and cervical mucous. However, the sperm still must swim from the uterus to the correct fallopian tube, find the egg, attach to the egg, penetrate the egg’s shell (the zona), enter the egg and fertilize the egg. Each of these steps still requires a sufficient number of swimming sperm that are shaped normally to have a reasonable chance for success.

Intrauterine insemination (IUI) is a common infertility treatment. It can be used in cases where the male has a low sperm count, unexplained infertility or when the female is not ovulating regularly. Ovulation inducing drugs are usually used as well.

In this technique, semen is collected into a sterile cup by masturbation or into a special condom sheath used during intercourse and then brought to the office laboratory. It is prepared in special media, similar to that used for IVF. The objective of IUI is to insert a concentrated quantity of sperm directly into the uterus bypassing the cervix. Since IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract, the sperm function of the male must be reasonable and the fallopian tube(s) must be healthy and functional. Sperm function includes sperm number, shape and movement. The sperm wash takes about 45 minutes to 2 hours depending on the technique utilized. An IUI takes approximately 10-15 minutes to complete.

Timing of the insemination to coincide with ovulation is critical. In order to ensure this occurs, timing of ovulation is monitored by urinary hormone tracking methods or sonogram. Urinary LH ovulation predictor kits indicate that ovulation will occur within a 24 to 48 hour window. The urinary tracking method is performed at home, generally in the late afternoon or early evening. When the test is “positive”, insemination is performed 24 to 36 hours later. Another method used to time ovulation is sonography. The development of the follicle and impending release of the egg can be timed by serial ultrasounds performed in the office. Sonograms to time IUI’s are usually used when the patients are taking oral or injectable infertility medicine. Patients generally use an hCG injection to further ensure release of the egg.

In Vitro Fertilization with Intracytoplasmic Sperm Injection (IVF with ICSI)

If sperm number, percentage swimming forward or normally shaped is too low the chance for successful conception with IUI will be significantly decreased. Options at that point include either the use of donor sperm or proceeding with IVF and ICSI. The procedure involves removing eggs directly from the woman’s ovaries through the vagina under ultrasound guidance using sedation anesthesia. Usually medications that stimulate the ovaries to produce numerous eggs are utilized to prepare for the procedure. After the eggs are retrieved, a single sperm, selected based on shape and motility, is drawn into a glass needle (the diameter of which is smaller than a human hair) and then injected directly into the egg. The embryologists must be highly skilled and trained in micromanipulation techniques to perform ICSI correctly. RMG’s embryologists have successfully performed thousands of ICSI procedures.

Semen Analysis

This is the first, and most important, test performed on the male during an infertility work-up. Abnormalities in semen parameters (male factor) contribute to infertility in approximately 40% of couples. In many cases, this will be the only test required for the male. Sometimes, the semen analysis will need to be performed more than once.

The specimen is collected by masturbation into a collection container after abstaining from ejaculating for 2-7 days. It is best if it can be collected at one of our office laboratories, however, if that is not possible, it may be collected at home and brought to our laboratory within 1 hour of collection time. Be sure to record the time of collection. After collecting the specimen, keep it at body temperature by placing it in your shirt pocket or wrapping it in a towel. Do not expose the specimen to extreme temperatures such as air conditioners or heater vents. More information will be provided when the procedure is scheduled

Many aspects of the semen are examined during the semen analysis. Assessment of volume (normal is > 1.5cc), concentration/count (normal is > 20 million per cc), motility/movement (expect at least 40% to be moving) and morphology/sperm shape (need to have a t least 3% with normal shape according to strict criteria) is made. In addition, viscosity (thickness/ability to liquify), presence of bacteria or white blood cells and pH are observed.

If one or more parameters are abnormal, a repeat analysis will be required. If repeat test results are significantly abnormal then a urologic evaluation may be recommended.