| المجلد 5 , العدد 1 , شوال 1429 - تشرين الأول (أكتوبر) 2008 |
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| How are the Sperm Processed in the Laboratory for IUI? |
| د. زينب إدلبي Edlbi Z. |
| الملخص Abstract |
| يُعد التلقيح الصناعي أحد الطرق المستخدمة في علاج العقم البدئي، وهو مؤشر أولي لاختبار عمل المبيض، حيث تؤكد الدراسات أن إجراء محاولتين أو ثلاث تلقيحات صناعية قبل التوجه إلى عملية طفل الأنبوب مجدية لزوجين، تتمثل سيمات العقم لديهما بأحد تلك المواصفات: عقم مجهول السبب، عقم ذكري مشخص مخبرياً؛ ضعف في التعداد، لكن ليس أقل من مليون، مع نسبة عاليه في الحركة، وسلامة شكل النطفة؛ ضعف في نسبة الحركة، نسبة مورفولوجيا النطاف غير الطبيعية لا تزيد عن 15%، وجود كريات بيض في السائل، حالات القذف التراجعي)، وتشكل اختيار طرق معالجة النطاف أهمية كبيرة في نسبة النجاح بالتلقيح الصناعي، وتقانات الإخصاب المساعد. ذلك أن البويضة تسعى إلى اختيار النطفة ذات الجودة العالية، وفي حال عدم توفرها. تتجاوب لاختيار قسري في التلقي، وتعطي أجنة ذات طاقة محدودة في التعشيش. للحصول على نتائج أفضل في هذا المضمار، يدأب علماء الأندرولوجي في مواصلة البحث لا يجاد طرق متطورة في معالجة النطاف. ومن خلال هذه الدراسة الموجزة تتوضح المفارقات في تطور المعالجة باستخدام البنتوكسيفللين pentoxyfylline، مناخ الحضن، نوعية الوسط المستخدم، والمناخ الملائم للمعالجة. |
| Sperm Processing |
| Sperm processing allows the doctor to concentrate the actively motile sperms into a small volume of culture fluid. Sperm do not remain alive in the culture medium for very long unless maintained at the right conditions - hence a prompt insemination after sperm processing is important. This is why processing should preferably be done in the clinic itself, so that time is not wasted in transporting the sperm after the wash. |
| Laboratory Techniques: |
There are different methods of processing the sperm, and all of these
require special laboratory expertise
1-The simplest method is that of washing the semen with a culture medium (by centrifuging it and collecting the pellet) but this is a poor technique and is not recommended.
2-The swim-up method uses a layering technique, in which a special culture medium is placed above the semen in a test-tube. The good quality sperm will swim up into the culture medium; and after 45 to 60 minutes, this medium (with the motile sperms) is removed and injected into the uterine cavity.
3-The more sophisticated methods today use a density gradient column. This method allows one to separate the good quality sperm from the immotile sperm, the pus cells and the seminal plasma, because these are lighter than the motile sperms. It provides the best recovery of motile sperms and is the standard technique in use today, especially for poor quality sperm samples.
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| What recent advances have occurred in IUI treatment? |
Recent advances of late, doctors have tried adding various chemicals to the washed sperm to try to improve their motility, so as to increase the chances of their reaching their goal. These chemicals include caffeine and pentoxyfylline (increase motility 3 hours at incubation time) and they may be helpful in some patients.
After treatment better to do incubation for sample in CO2 5%, the pH of sperm will be closed to cocyte in fallopian tubes environment (the concentration of the gases oxygen and carbon dioxide are different in the oviduct compared to in the uterus, which in turn reflects pH Right temperature of incubation 36°C will supported the motile sperm more alive
Co-culture media used to protects the embryos from free oxygen radicals especially for patient has failed trial
Media appeared to possess the ability to provide additional protection to embryos from certain embry-toxic substance
Sperm treatment better in low light because it is one of multiple sources of ROS (reactive oxygen species), light is able to induce ROS production and cellular damage such as DNA strand breaks
During IUI, sperms are injected into the uterine cavity in the hope that they will then swim up from here into the fallopian tubes where they can fertilize the egg. But then, why not inject the sperms direct into the fallopian tubes where the eggs is present? This feat was technically difficult to accomplish in the past, because the tubes are so thin. Today, with specially designed thin catheters, it is possible to do this in the doctor's clinic. Thus, the processed sperm can be injected directly into the tubes under ultrasound guidance, without anesthesia or surgery! This is an intratubal insemination - also known as a SIFT-(sperm intra-fallopian transfer). However, pregnancy rates are no better with this method than with IUI, which is why it is rarely performed today
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| Psychological effecting Issues (Main points consideration). |
| Men may feel a loss of self-esteem because they feel that they need a doctor's help to do what a "normal man" should have been able to do by himself. They also feel guilty about having to subject their wife to the pain and intrusion of insemination. Women may feel anger towards their husbands for having the fertility problem. The insemination may also make patients feel that someone has "intruded" into their sex life and this may affect their intimacy. |
| Reference |
1- Aniruddha Malpani and Anjali Malpani
Overcoming Infertility:
Bio-Med, 15, 69-75, Free radical
2-Eds A. lauria et al.
Roma. 239-272.
3-Fertil Steri.
Fertility laboratories of colorado
65 (2): 349-353l, 1996.
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| المجلد 5 , العدد 1 , شوال 1429 - تشرين الأول (أكتوبر) 2008 |
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