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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 ?