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Treatment Options:
Sperm Preparation and Artificial Insemination
Sperm Preparation is a rapidly advancing science used to improve sperm quality. Several preparation techniques are available to address different sperm quality problems. Once a diagnostic analysis is complete the appropriate sperm preparation will be used to enhance the sperms ability to achieve a pregnancy with artificial insemination.
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Artificial Insemination
The chances of becoming pregnant are better if sperm are deposited in the woman on the day of ovulation, when an egg is released from the ovary. Artificial insemination of a prepared sperm sample is done when the female partner is ovulating. (Please see Ovulation Timing by LH Kit Testing .) The day you note a big rise in the LH hormone is the day before ovulation should occur.
Please see Artificial Insemination - a treatment for infertility for more information.
Many physicians have additional requirements, such as blood tests or a current pap and pelvic exam, that they require before they will perform an insemination. Be sure to communicate with your physician in advance to avoid any delays.
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Chances of Success
Using sperm preparation along with properly timed artificial insemination by identifying the woman’s LH surge, (Please see Ovulation Timing by LH Kit Testing ) the chances of achieving a pregnancy through six cycled attempts are between 15 and 40%. Though no one technique comes in "one size fits all," there is a good probability that one of the techniques may be applicable to most circumstances.
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Requirements for Recipients of Prepared Sperm
Please ask your physician to fax a sperm preparation requisition to (801) 581-6127, before your insemination. The order needs to have your name, date, requested sperm preparation and the doctor’s signature. |
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Sperm Washing |
This technique removes the sperm from its natural fluid and places it in an artificial fluid that allows intra-uterine insemination, improves sperm motility, longevity and its ability to penetrate the egg. This procedure takes about 20 minutes after the semen is liquefied. The wash is done the day of the insemination and the sperm are then placed on the cervical mucus or directly into the uterus depending upon the couple’s particular infertility problem. Washing is the most helpful process to handle fragile sperm, such as frozen-thawed and sperm with antibodies. |
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Density Gradient |
Large scale studies have determined the sperm preparation technique that has shown the best results for patients with a normal count and HEPT result is the density gradient centrifugation procedure. The sperm are washed then separated by putting it through two different concentrations of a colloidal solution. This separates the sperm with the best movement from those with poor or no movement. It also helps to reduce or eliminate the presence of white blood cells. The procedure takes about one or two hours to complete. Occasionally, this technique cannot be used due to the sperm count or motility being too low. In such cases other techniques may be used. |
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Refrigeration/Heparin Incubation |
If the HEPT suggests a capacitation or acrosome reaction defect, a sperm penetration enhancing treatment may be employed. The technique involves obtaining two sperm samples about 24 hours apart. The first sample undergoes refrigeration in a capacitation-stimulating medium; the second sample is incubated with the chemical heparin. Both of these treatments help to improve the sperm’s penetration capacity increasing its ability to fertilize. If the patient’s semen sample is unable to fertilize, ICSI may be used or donor sperm may be purchased for insemination.
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Sperm Incubation |
The sperm incubation enhances the motility of the sperm and the ability of the sperm to penetrate the egg. It also concentrates sperm and eliminates prostaglandins in the seminal fluid, which may cause intrauterine cramping.
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Sperm Swim Up/Swim Down |
The sperm swim up serves to select the most motile sperm and enhance the motility and the ability of the sperm to penetrate the egg. It also eliminates prostaglandins in the seminal fluid, which may cause intrauterine cramping and may help to isolate sperm with better morphology.
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Pentoxifylline Incubation |
Pentoxifylline is a phosphodiesterase inhibitor and improves sperm motility by inhibiting the breakdown of c-AMP. The pentoxifylline incubation also concentrates sperm and eliminates prostaglandins in the seminal fluid, which may cause intrauterine cramping.
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Other Options
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Retrograde, Vibratory Stimulation, and Electroejaculation |
Patients with retrograde ejaculation can yield acceptable samples for intrauterine insemination. Vibratory stimulation and electrical ejaculation have been shown to be effective to obtain semen samples in at least a percentage of men with spinal cord injuries. The retrograde, vibratory stimulation, and electroejaculation sperm was serves to concentrate available sperm, enhance motility, and eliminate prostaglandins in the seminal fluid, which may cause intrauterine cramping.
Liquefied semen is mixed with mixed with commercial media, centrifuged and decanted to remove the supernatant. Retrograde samples are also evaluated and may be washed with commercial media and combined with washed ante grade samples for direct intrauterine insemination or utilized separately as an intra-cervical insemination. This preparation may be combined with other preparations such as a density gradient separation to remove white blood cells or other unwanted debris |
Drug Therapy |
Although men with abnormal hormone production may benefit from hormone therapy, most men with decreased sperm counts have normal hormone levels and do not benefit from such therapy. Hormonal therapy is evaluated by an Endocrinologist or urologist.
Medications used for men include: clomiphene citrate, hCG and tamoxifen. Clomiphene increases FSH and LH levels, which are regulated in the pituitary, as is sperm production. Males take clomiphene orally every day for four to six months to allow time for the improvement of sperm production. Typically, there is a 10 to 15 percent success rate for this type of medication.
If a man’s sperm count and quality are extremely low, injections of hCG may be used. This is a medication that goes directly to the testicle and causes it to produce a high testosterone level, which is necessary for normal sperm production.
Tamoxifen blocks the action of the female hormone that is produced by the testicle in small amounts. The idea behind this is in blocking the production of female hormone, it will allow for better sperm production.
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Surgical Therapy |
The most prevalent corrective surgery for men is varicocelectomy; the ligation of a dilated vein or group of veins from the scrotum. Surgery may also be necessary to repair blockage of the vas deferens. A urologist can provide a physical examination to determine blockage or varicoceles.
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Physicians
