CONTROVERSIES IN IUI

MODULATION OF SPERM MOTILITY

WHETHER TO USE SPERM MOTILITY ENHANCING AGENTS FOR PROCESSING OF SPERMS IN ARTIFICIAL INSEMINATION OR NOT ?

SPERM MOTILITY ENHANCING AGENTS

Pentoxyphylline Caffine 2-deoxyadenosine Progesterone Taurine/Hypotaurine Nitric oxide Hyaluronic acid

PENTOXYPHILLINE

Most widely used Acts as phosphodiesterase inhibitor Enhances concentration of cyclic AMP Used in ceoncentrations of 0.5-1.0 mg/ml

Enhances motility if incubated for a brief period in vitro.

CAFFINE

Similar to Pentoxyphilline Action is through inhibition of phosphodiesterase and increasing contentration of cyclic AMP. Stimulates ascrosomal reaction and premature shedding of acrosome

2-DEOXYADENOSINE

Stimulates adenylate cyclate enzyme and increases concentration of Cyclic AMP The stimulatory effect is not consistant and varies patient to patient May be effective only when there is documented deficiency of adenylate cyclase enzyme

PROGESTERONE

Natural female hormone Induces acrosomal reaction and motility Also improvs longevity of sperm Postulated that progesterone is one of the components for stimulation and capacitation of sperm in female tract

TAURINE/HYPOTAURINE

Derived mainly from aminoacid cysteine Work as antioxidents in sperms Postulated that the female tract secrets these substances and enhances in vivo sperm activities.

HYALURONIC ACID

Unbranched polysaccharide Abundantly found in cervical mucus Increases sperm velocity Prolongs longevity

CAN PENTOXYPHILLINE INCREASE PREGNANCY RATES IN IUI?

Enhances motility Limited evidence of pregnancy rate increase May not be effective in normal sperms with normal cAMP mechanisms.

CAN PENTOXYPHILLINE INCREASE PREGNANCY RATES IN IVF?

IVF provides controlled study platform Pentoxyphilline improves pregnancy rates in sperms showing acrosome reaction deficiency Non selective use may be detrimental to IVF Exposure of oocytes to pentoxyphilline is not recommended

TREATMENT OF MALE INFERTILITY DUE TO SPERM SURFACE ANTOBODIES : IUI OR IVF?

EFFECT OF ANTISPERM ANTIBODIES

FOUND AT MANY SITES
SEMEN CERVICAL MUCUS SERUM FOLLICULAR FLUID TUBAL FLUID

SPERM AGGLUTINATION

ANTISPERM ANTIBODIES
MECHANISMS OF FERTILITY IMPAIRMENT Immobilization of Sperm Agglutination of sperm Inhibition of sperm transport Inhibition of fertilization

DIAGNOSTIC TESTS FOR ANTISPERM ANTIBODIES

MIXED ANTIGLOBULIN TEST (MAR) IMMUNOBEAD TEST (IBT) ELISA TESTS INDIRECT TEST
POST COITAL TEST (PCT) Kremer device

SPERM CERVICAL MUCUS INTERACTION

TREATMENT
Antibodies in Semen Sperm Washing and Ejaculating into serum Chymotrypsin/galactose treatment Corticosteroid treatment Antisperm antibodies in cervical mucus IUI

TREATMENT

IUI vs IVF and ICSI WHICH TREATMENT ?