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MagnoliaGirl - December 15th, 2006 10:32 AM

Hi :)

My husband and I are approaching our 3rd IUI next week. My husband's sperm count on our last IUI wasn't very good (15 million, 10 after the wash, we abstained a little less than 48 hours prior to collection), but on our first one it was much better (31 million, we abstained closer to 60 hours prior to collection). Morphology isn't great (1%). I know that counts tend to be "dynamic" and there are many things that can affect them, but do you think the abstinence time is a factor? What would be the optimum abstinence period for us prior to the IUI? Also, my nurse told me that my RE mentioned trying a gradient wash this time. What does that do and will it help? Do you have any other advice?

Thanks so much for your help!

Dr Smith - December 18th, 2006 10:06 AM

Here's yer answer:

Effect of ejaculatory abstinence period on the pregnancy rate after intrauterine insemination.
Jurema MW, et al.
Fertil Steril. 2005 Sep;84(3):678-81.

[b]OBJECTIVE:[/b] To determine the optimal interval of ejaculatory abstinence for couples undergoing IUI.
[b]CONCLUSION(S):[/b] An abstinence interval of 3 days or less was associated with higher pregnancy rates following IUI. Prolonged abstinence decreases pregnancy rates, independent of other sperm parameters, perhaps as a result of sperm senescence and functional damage not readily identified by standard semen analysis. Abstinence intervals should be controlled for in studies examining pregnancy outcome in assisted reproduction.

Density gradient centrifugation (DGC) is a technique for separating the "good" sperm from the "bad" sperm in an ejaculate. It is not rocket science and there are commerically available DGC "kits" designed for use in a doctor's office. IUI pregnancy rates are significantly higher when DGC is used to prepare the sperm for IUI.

Sounds like you are at an Ob/Gyn's office. If that's the case, seek a Reproductive Endocrinologist with an associated Andrology laboratory that can perform up-to-date sperm preparation methods. If you're still being treated at an OB/Gyn's office after 3 failed IUIs, move on.


MagnoliaGirl - December 18th, 2006 10:25 AM

Thanks, Dr. Smith! I am seeing an RE. Is there something more specific I should be asking them regarding semen prep?


MagnoliaGirl - December 18th, 2006 11:34 AM

Opps... okay, I'm embarrassed! I looked back at my notes from the last time I talked to the nurse at my RE's office and what he said was that we were going to do a NON-gradient wash. I'm not sure what type of wash they have done the previous times, maybe those were gradient washes? I'll ask him when I see him tomorrow. Sorry for asking a question based on the wrong information! I think infertility is making my brain turn to mush...

Dr Smith - December 18th, 2006 1:37 PM

Whew! Good news. No need to feel embarrassed, this stuff can be very confusing.

O.K. I think we can assume that you were having DGC to prepare the sperm in the previous IUIs. This is the standard method in RE practices. Your going retro and turning the way-back machine to the 1980's with a "simple wash". For a "simple wash", the semen is diluted with culture medium, centrifuged, and the sperm go to the bottom of the tube. The culture medium is thrown away and the whole process is repeated. At the end, the sperm are suspended in a smal volume of culture media and squirted into the uterine cavity. The good news is, this technique gets more sperm. The bad news is it gets all the junky sperm too. There is no separation of the good, the bad and the ugly. When bad/dead sperm are introduced into the uterine cavity, they alert the immune system to get rid of the bad/dead sperm. "Clean up on aisle 3!" as it were. The problem is, the white blood cells recruited to clean up don't know the difference between live sperm and dead sperm and gobble up both. So much for having more sperm.

For this reason, simple washes were abandoned in the '80s in favor of DGC, which is now the standard. My opinion, for what it worth, is don't waste your time on simple washes. If these were natural cycle IUIs, kick it up a notch to stimulated. If these were stimulated IUIs, move on to IVF.


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