Açıklanamayan İnfertilite Olgularında Uygulanan İntrauterin İnseminasyonlarda Sperm Hazırlama Yöntemlerinin Etkinliklerinin Geriye Dönük Karşılaştırılması

Year 2020, Volume: 4 Issue: 2, 132 - 136, 12.07.2020

Asli Yaylalı

https://doi.org/10.30565/medalanya.661870

Cited By: 1

Abstract

Amaç: Açıklanamayan infertilite tanısı almış çiftlerde, intrauterin inseminasyon (İUİ) tedavisi için kullanılan sperm hazırlama yöntemlerinin gebelik oranları üzerine etkilerinin karşılaştırılması. 

Yöntemler: Çocuk istemi nedeniyle tüp bebek merkezi’ne başvurmuş, kadında herhangi bir jinekolojik problem gözlenmemiş, erkekte semen analizi aşılama için uygun özelliklerde olan ve açıklanamayan infertilite tanısı alan 112 çift çalışmaya dahil edilmiştir. Hastalar sperm hazırlama yöntemlerine göre Grup I (Swim-Up), Grup II (Gradient), Grup III (Mikroçip) olmak üzere üç grupta değerlendirilmiştir. Sonuçlar istatistiksel olarak analiz edilip literatür eşliğinde tartışılmıştır. 

Bulgular: Çalışmaya dahil edilen çiftlerin yaşları, infertilite süreleri, kadınların bazal FSH değerleri, ovulasyon indüksiyonu ile oluşan dominant folikül sayısı, İUİ esnasındaki endometrium kalınlığı, sperm hazırlama öncesi total motil sperm sayısı, normal morfolojili (Kruger) sperm oranı, sperm hazırlama sonrası motilite oranı ve insemine edilen sperm sayıları arasında istatistiksel bir fark izlenmemiştir (Tüm p değerleri>0,05). Hastaların İUİ deneme sayısı Mikroçip grubunda 3,68 bulunmuş iken Swim-Up grubunda 1,86 ve Gradiyent grubunda 1,82 olarak tespit edildi. Mikroçip grubundaki daha fazla İUİ deneme sayısı diğer gruplara göre istatistiksel olarak yüksek bulundu (p<0,01). Gebelik oranları karşılaştırıldığında ise en yüksek oran %22,73 ile Mikroçip grubunda tespit edilirken (Swim-Up grubunda %15,91, Gradient Grubunda %17,39) arada istatistiksel olarak anlamlı fark görülmemiştir (p= 0,064).

Sonuç: IUI sikluslarında sperm hazırlamada en sık kullanılan iki method (Swim-Up, Gradient) arasında bariz bir başarı farklılığı olmamakla bereber, günümüzde kullanımı gittikçe artış gösteren Mikroçip ile sperm seçme yöntemi umut verici bir alternatif olarak görülmektedir. Bu konuda daha fazla vaka sayısı ile birlikte, gebelik sonuçlarının da dahil edildiği prospektif randomize çalışmalara ihtiyaç vardır.

Keywords

İntrauterin inseminasyon,, İnfertilite,, Mikroçip,

Retrospective Comparison of the Efficiency of Sperm Preparation Methods in Intrauterine Insemination in Unexplained Infertility Cases

Abstract

Aim: To compare the effects on pregnancy rates of the sperm preparation methods used in intrauterine insemination (IUI) treatment in couples diagnosed with unexplained infertility.

Method: The study included 112 couples who presented at the Assisted Reproductive Techniques Clinic with no gynaecological problem observed in the female and semen analysis in the male showing features suitable for insemination, who were then diagnosed with unexplained infertility. The patients were evaluated in three groups according to the sperm preparation methods as Group 1 (Swim-Up), Group II (Gradient) and Group III (Microchip). The results were analyzed statistically and discussed in light of the relevant literature. 

Results: No statistically significant difference was determined between the groups in respect to the age of the couples, duration of infertility, female basal FSH values, number of dominant follicles formed with ovulation induction, endometrium thickness during IUI, total number of motile sperm before sperm preparation, ratio of sperm with normal morphology (Kruger), motility rate after sperm preparation, and number of inseminated sperm (p>0.05 for all). The mean number of IUI attempts was 3.68 in the Microchip group, 1.86 in the Swim-Up group and 1.82 in the Gradient group. A statistically significantly higher number of IUI attempts was made in the Microchip group than in the other groups (p<0.01). In the comparison of the pregnancy rates, the highest rate of 22.73% was determined in the Microchip group, followed by 17.39% in the Gradient group and 15.91% in the Swim-Up group, with no statistically significant difference determined between the groups (p=0.064). 

Conclusion: Although there was no apparent difference in success between the two methods most frequently used in sperm preparation in IUI cycles (Swim-Up, Gradient), the method of sperm selection with Microchip, which is being increasingly used, seems to be a promising alternative. There is a need for further

Keywords

İnfertility, Microchip, Intrauterin insemination,

References

• 1. Ricci G, Perticarari S, Boscolo R, Montico M, Guaschino S, Presani G. Semen preparation methods and sperm apoptosis: swim-up versus gradient-density centrifugation technique. Fertil Steril. 2009;91(2):632-8.
• 2. Boomsma CM, Cohlen BJ, Farquhar C. Semen preparation techniques for intrauterine insemination. Cochrane Database Syst Rev. 2019 Oct 15;10:CD004507. doi: 10.1002/14651858.CD004507.pub4.
• 3. Wainer R, Albert M, Dorion A, Bailly M, Bergere M, Lombroso R, Gombault M, Selva J. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination Hum Reprod. 2004;19(9):2060-5. DOI:10.1093/humrep/deh390.
• 4. Berg U, Brucker C, Berg FD. Effect of motile sperm count after swim-up on outcome of intrauterine insemination. Fertil Steril 1997;67(4):747-750. DOI: 10.1016/s0015-0282(97)81377-5.
• 5. Horvath PM, Bohrer M, Shelden RM, Kemmann E. The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination. Fertil Steril 1989;52(2):288-94. DOI:10.1016/s0015-0282(16)60857-9.
• 6. Samuel R, Feng H, Jafek A, Despain D, Jenkins T, Gale B. Microfluidic-based sperm sorting & analysis for treatment of male infertility. Transl Androl Urol. 2018;7(Suppl 3):S336-S347. DOI:10.21037/tau.2018.05.08.
• 7. Yetkinel S, Kilicdag EB, Aytac PC, Haydardedeoglu B, Simsek E, Cok T. Effects of the microfluidic chip technique in sperm selection for intracytoplasmic sperm injection for unexplained infertility: a prospective, randomized controlled trial. J Assist Reprod Genet. 2019;36(3):403-9. DOI:10.1007/s10815-018-1375-2.
• 8. Dodson WC, Moessner J, Miller J, Legro RS, Gnatuk CL. A randomized comparison of the methods of sperm preparation for intrauterine insemination. Fertil Steril. 1998;70(3):574-5. DOI:10.1016/s0015-0282(98)00210-6.
• 9. Depypere H, Milingos S, Comhaire F. Intrauterine insemination in male subfertility: a comparative study of sperm preparation using a commercial Percoll kit and conventional sperm wash. Eur J Obstet Gynecol Reprod Biol. 1995;62(2):225-9. DOI:10.1016/0301-2115(95)02196-e.
• 10. Posada MN, Azuero AM, Arango AM, Raigosa GC, Cano JF, Perez AL. Sperm washing with swim-up versus gradients in intra uterine insemination (IUI): results of a prospective randomized study comparing pregnancy rates and costs. Fertility and Sterility Abstract book 61st ASRM meeting. 2005; Vol. 84 Suppl 1:361.
• 11. Tomlinson M, Mandrioli M, Bizzaro D, Bianchi PG, Bianchi U. The use of two density gradient centrifugation techniques and the swim-up method to separate spermatozoa with chromatin and nuclear DNA anomalies.Hum Reprod. 2000 May;15(5):1112-6. doi: 10.1093/humrep/15.5.1112.
• 12. Ricci G, Perticarari S, Boscolo R, Montico M, Guaschino S, Presani G. Semen preparation methods and sperm apoptosis: swim-up versus gradient density centrifugation technique. Fertil Steril. 2009;91(2):632-8. DOI:10.1016/j.fertnstert.2007.11.068.
• 13. Aitken RJ., Clarkson JS. Significance of reactive oxygen species and antioxidants in defining the efficacy of sperm preparation techniques. J. Androl. 1988;9(6):367-76.
• 14. Zhang X, Khimji I, Gurkan UA, Safaee H, Catalano PN, Keles HO, Kayaalp E, Demirci U. Lensless imaging for simultaneous microfluidic sperm monitoring and sorting. Lab Chip. 2011;11(15):2535-40. DOI:10.1039/c1lc20236g.
• 15. Gode F, Bodur T, Gunturkun F, Gurbuz AS, Tamer B, Pala I, Isik AZ. Comparison of microfluid sperm sorting chip and density gradient methods for use in intrauterine insemination cycles. Fertil Steril. 2019;112(5):842-848.e1. doi:10.1016/j.fertnstert.2019.06.037.