Controversies in Iui
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Transcript of Controversies in Iui
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7/30/2019 Controversies in Iui
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CONTROVERSIES IN
IUI
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MODULATION OF SPERM
MOTILITY
WHETHER TO USE SPERM MOTILITYENHANCING AGENTS FOR PROCESSING
OF SPERMS IN ARTIFICIAL
INSEMINATION OR NOT ?
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SPERM MOTILITY ENHANCING
AGENTS
Pentoxyphylline
Caffine
2-deoxyadenosine Progesterone
Taurine/Hypotaurine
Nitric oxide Hyaluronic acid
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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 briefperiod in vitro.
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CAFFINE
Similar to Pentoxyphilline
Action is through inhibition ofphosphodiesterase and increasingcontentration of cyclic AMP.
Stimulates ascrosomal reaction andpremature shedding of acrosome
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2-DEOXYADENOSINE
Stimulates adenylate cyclate enzyme andincreases concentration of Cyclic AMP
The stimulatory effect is not consistantand varies patient to patient
May be effective only when there isdocumented deficiency of adenylatecyclase enzyme
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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
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TAURINE/HYPOTAURINE
Derived mainly from aminoacid cysteine
Work as antioxidents in sperms
Postulated that the female tract secretsthese substances and enhances in vivosperm activities.
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HYALURONIC ACID
Unbranched polysaccharide
Abundantly found in cervical mucus
Increases sperm velocity Prolongs longevity
C O
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CAN PENTOXYPHILLINE
INCREASE PREGNANCY RATES
IN IUI? Enhances motility
Limited evidence of pregnancy rate
increase
May not be effective in normal spermswith normal cAMP mechanisms.
CAN PENTOXYPHILLINE
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CAN PENTOXYPHILLINE
INCREASE PREGNANCY RATES
IN IVF? IVF provides controlled study platform
Pentoxyphilline improves pregnancy rates
in sperms showing acrosome reactiondeficiency
Non selective use may be detrimental to
IVF Exposure of oocytes to pentoxyphilline is
not recommended
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TREATMENT OF MALEINFERTILITY DUE TO SPERM
SURFACE ANTOBODIES : IUI OR
IVF?
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EFFECT OF ANTISPERM
ANTIBODIES
FOUND AT MANY SITES
SEMEN
CERVICAL MUCUS
SERUM
FOLLICULAR FLUID
TUBAL FLUID
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SPERM AGGLUTINATION
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ANTISPERM ANTIBODIES
MECHANISMS OF FERTILITY
IMPAIRMENT
Immobilization of Sperm
Agglutination of sperm
Inhibition of sperm transportInhibition of fertilization
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DIAGNOSTIC TESTS FOR
ANTISPERM ANTIBODIES
MIXED ANTIGLOBULIN TEST (MAR)
IMMUNOBEAD TEST (IBT)
ELISA TESTS
INDIRECT TEST
POST COITAL TEST (PCT) Kremer device
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SPERM CERVICAL MUCUS
INTERACTION
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TREATMENT
Antibodies in Semen
Sperm Washing and Ejaculating into
serum
Chymotrypsin/galactose treatment
Corticosteroid treatment
Antisperm antibodies in cervical mucusIUI
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TREATMENT
IUI vs IVF and ICSI
WHICH TREATMENT ?