A Comparative Study of Swim-up and Upstream Methods for Isolating Sperm Cell for Intra Uterine Insemination

There are more than 80 million infertile couples around the world (1). It is estimated that about 40 million of infertile couples are currently seeking infertility treatments (2). Treatment of infertility ranges from simple advice on natural conception to complex and expensive interventions including Assisted Reproductive Technologies (ART) (3). Advanced infertility treatment methods are costly and most people especially in developing countries are deprived of such treatments (4,5). Even in a developed country like Canada, this costly treatment seems to suit only those who could afford it (6). Along with ART the most common form of medical intervention to treat infertility is Intra Uterine Insemination (IUI), whereby prepared sperm cells are deposited directly into a woman’s uterus to aid conception (3). Approximately 30% of the infertility cases are unexplained (7). Most experts consider IUI as the primary treatment for unexplained infertility (8). Several studies attest to the effectiveness of IUI and it is considered a simple and inexpensive fertility treatment (9). It is also reported that these same characteristics had allowed IUI procedure to be performed by nurses with comparable results to those performed by physicians (10). We think that augmented use of IUI procedure, in general, and easier application of the procedure in medical offices, in particular, demands for simpler and inexpensive processes that would not require specialist and sophisticated equipment for preparing sperm cells. Currently, swim-up and density gradient are the standard methods of sperm cell separation and in some cases glass wool filtration method is also used. In these techniques, considerable amount of active sperm cell with normal morphology and high fertility potential can be separated (11). All of these methods require the use of centrifugal separation. Aitken and Clarkson discovered that centrifugal separation could result in producing free radicals which subsequently could damage the sperm cell. Following a thorough review of the results of researches in this area, Mortimer also concluded that the preparation methods which used centrifugal separation could damage the sperm cell, decrease its fertility potential, and reduce the rate of pregnancy (12). Previously we observed that when sperm cells were exposed to the flow of fluid, their randomized movement changed to organized and synchronized swim against the Abstract Objectives: Sperm cell preparation is an important step in the advanced treatment of infertility. Among the different methods introduced, none are considered to be ideal. The common methods are based on utilizing centrifugal separation which has been proven to be harmful to the sperm cell. We developed a method, based on the motion against the flow of sperm cell, which can successfully separate active sperm cells. Materials and Methods: In this study, we investigated the efficacy of this approach with a randomized clinical trial. Fifty-one candidates for the intra uterine insemination (IUI) treatment participated in our study. Twenty-five cases were assigned to our test group, separating the sperm cells using the proposed method (upstream method), and the conventional swim-up method was applied to 26 cases in our control group. The entire process of IUI treatment in both groups was exactly the same except for the methods of separating sperm cells. Results: Results showed that the pregnancy rate using the new method was 20%, while the common method of sperm cell preparation resulted in 15.3% pregnancy rate. Conclusion: The new sperm preparation method (Upstream method) can be used as a simple, quick and effective method of sperm cell separation in fertility treatment especially in IUI procedure.