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Comparative efficacy of density gradient and swim-up methods of semen preparation in intrauterine insemination cycles.

OBJECTIVE
To see the efficacy of different methods of intrauterine insemination preparation for sperm recovery and conception rate.


METHODS
This prospective observational study was carried out at Chohan Reproduction and Assisted Fertility Treatment Centre, Lahore, Pakistan, from January 2014 to July 2014, and comprised infertile couples undergoing intrauterine insemination cycles. Method of sperm preparation for intrauterine insemination during super-ovulation was randomly assigned for swim-up and density gradient techniques. Total sperm count, percentage recovery of motile sperm count, conception rate and cycle fecundity (live births, miscarriages, ectopic pregnancy) were measured.Mean percentages of sperm recovery and motility were compared. SPSS 21 was used for data analysis.


RESULTS
Of the 220 couples who underwent 440 cycles, 138(62.7%) suffered from primary infertility and 82(37.27%) from secondary infertility. The mean age of women was 31.75±5.47 years, while that of men was 35.78±5.27 years. Mean duration of infertility in these couples was 5.50±3.51 years. Intrauterine insemination was performed at the first attempt in 180(81.8%) couples, at the second attempt in 37(16.8%) and at the third attempt in 3(1.3%) couples. Mean percentage of sperm motility in post-preparation of density gradient procedure was 83.88±15.02 (day 1) and 84.02±18.51 (day 2) while in swim-up procedure it was 91.02±11.85 (day 1) and 92.28±9.89 (day 2). Mean percentage of sperm concentration after processing in density gradient procedure was higher than swim-up (p=0.368 day 1; p=0.225 day 2) but mean percentage of sperm motility in post-preparation of density gradient procedure was less than swim-up procedure (p=0.000 day 1; p=0.000 day 2). Recovery rates in density gradient were 50.89% on day 1 and 5 13% on day 2compared to 36.69% on day 1 and 37.5%on day 2in swim-up technique (p=0.02). Conception rate was 15%.


CONCLUSIONS
Despite the difference in percentage recovery of motile sperms in different techniques, cycle fecundity remained the same.