2010년 유럽불임학회(ESHRE) P-046 IUI outcome is not affected adversely by prolonged incubation of washed sperm at room temperature until IUI is performed. (인공수정 시술에서 처리된 정자를 오랜기간 배양하는 것이 임신율에 영향을 주지 않는다.)

E.M. Cha1, J.H. Lee1, I.H. Park1, K.H. Lee1, M.H. Kim2
1 Mamapapa&baby Hospital, Infertility Lab, Ulsan, Korea South
2 Ellemedi OBGY, Changwon, Kyeong Sang Nam-do, Korea South

INTRODUCTION

It is known that prolonged exposure of sperm to seminal plasma is harmful to sperm motility. Also, incubation of washed sperm in media prepared for intrauterine insemination or in vitro fertilization treatment could be a factor of hyperactivation, one proposed marker for capacitation as well known. Even though the processed sperm has good quality, not all women inseminated could expect positive outcome. We hypothesized that the pregnancy rate of IUI would be affected by prolonged exposure of processed sperm to media. Thus the objective of our study is to determine the correlation between time intervals from the end of sperm wash to intrauterine insemination and IUI outcome.

DESIGN

Retrospective study

MATERIALS AND METHODS

192 IUI treatment cycles performed from June 2009 to December 2009 were analyzed. Women received 50~150mg of clomephene citrate(cc) daily for consecutive days. Follicular development was monitored by trans-vaginal ultrasound. In 34~38 hours after administration of hCG, a single IUI were performed by physician. Semen specimens were produced either at our clinic or at home. After liquefaction, sperm wash was performed by a density gradient centrifugation. Investigator recoded the time start of sperm wash and time finish of sperm wash. Processed semen was placed in RT (Room Temperature) until IUI was performed. Time of IUI was also recorded by physician. All women had a serum pregnancy test 15 days after insemination. Our study population is divided into two groups based on the time intervals from the end of sperm wash to IUI.
group A: ≤30 minutes, n=74 (n: number of women performed IUI)
group B: >30 minutes, n=118 (n: number of women performed IUI)

RESULTS

Female ages ranged 27~48 years with a median of 37 years. There was no difference between Group A and B including female ages, indication, methods of sperm processing, processed sperm. Time intervals from the end of sperm wash to IUI ranged 2~194 minutes with the mean 43 minutes. Total IUI pregnancy rate was 16.7% (32/102).
Pregnancy rates have no significant difference between group A (15/74, 20%) and group B (17/118, 14%) but it shows that probability of pregnancy was regressed a little against time interval.

CONCLUSION

Our result shows that the pregnancy rate is slightly declined in group B. This result is supported by fertility ability of sperm decreases when sperm exposes to media excessively. We supposed there are two factors influence to fertility ability of sperm. First, prolonged incubation of sperms in media affects to motility of sperms by exhaustion of energy sources in medium by spermatozoa. Second, present premature capacitation which including hyperactivation is a negative factor to fertility ability because hyperactivated sperm cannot traverse the uterotubal junction. Premature capacitation of washed sperm may occur due to removing of seminal plasma. Meanwhile sperm incubation at room temperature produces a temporary blockage of capacitation related events. Both hypotheses support early performing of IUI after sperm wash produces better IUI outcome. It seems that our data doesn’t show the difference between group A and B because we keep washed sperm at room temperature. Thus we recommend IUI should be performed as soon as sperm processing is completed, otherwise sperms should be placed at RT until IUI is performed.