Ginekologia i Poloznictwo
ISSN 1896-3315 e-ISSN 1898-0759

Impact of the sperm swim-up technique in semen processing on the success of Intrauterine Insemination (IUI) for Iraqi infertile couples

Saba Sabeh Hussain¹, Muhjah Falah Hassan², Safa Jihad³ and Hayder Ridha-Salman^{4* *}Correspondence: Hayder Ridha-Salman, Al-Mustaqbal University, College of Pharmacy, Iraq,

Received: 06-Mar-2025, Manuscript No. gpmp-25-164876; Editor assigned: 07-Mar-2025, Pre QC No. P-164876; Reviewed: 28-Mar-2025, QC No. Q-164876; Revised: 04-Apr-2025, Manuscript No. R-164876; Published: 30-Jun-2025

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Introduction

Fertility rate has been lowered globally due to advancement in contraceptive manufacture [1]. Culture norm and social habits are changing as women tend to prefer work over childbearing [2, 3] in addition to some endintocrine-disrupting chemicals that can interfere with normal hormonal activity [4]. Infertility is defined as inability to have babies after one year from continues sexual intercourse [5, 6]. Historically, the Intrauterine Insemination (IUI) has been unraveled in the 20^th century. IUI means use of artificial skills to elevate the likelihood to conceive a woman [7]. In (IUI) a processed semen sample forced in the upper uterine area, sperm will pass the obstacles represented by barriers in the female reproductive tract [8]. Although IUI is expensive, but it is effective and harmless therapy. The selected group of women for IUI should have normal tubes ovulation, while men can be advised to do IUI if they have immunological issues, and ejaculatory disorders [9]. Progesterone is required for preparation of the uterus for embryo implantation [10, 11]. It is well known that any reduction in the concentration of serum progesterone during early stages of pregnancy results in abortion [12, 13]. Thyroid diseases have proven clinically to cause infertility, so ladies who have shown thyroid gland imbalance was dismissed from the project [14]. Our research has positive impact on the community as we see the psychological problems that infertile couples have such as anxiety and depression [15].

The aim of current study is to evaluate the using swim-up technique of semen processing activated the sperm and increases its vitality and the effect of this technique on pregnancy rate in female undergoes IUI.

Material and Methods

Infertile couples have been seen in the Al-Hussein infertility center and in our private clinic for the period of September 10-2021 to May 2022. We have chosen 200 cases (n=200) for a total of 500 women to be treated by IUI. Those ladies are suffering from infertility due to cervical factors, anovulation and immunological factors. We used this method also if the male’s sperm analysis has shown poor sperm movements, clotting and clumps. The standard IUI is accomplished as described by another group of researchers.

Informed consent

Oral and written consent was collected from all couples before the treatment.

Laboratory IUI preparation

Semen analysis: Semen has been tested according to WHO recommendations [16], for all males included in the study. The semen test has been done one week prior to the operation and repeated on the IUI operation day to make sure it is suitable to go further with conception aid.

Hormonal analysis

Hormonal tests of blood have been performed to all couples. For male we tested testosterone, T3, T4. While, for female we tested LH, FSH, T3, T4, prolactin and progesterone [17-21]. For few cases of women who suffer previous incidence of abortion TORCH test has been performed to treat any reason that could kill the embryo [22, 23]. Moreover, internal exam has been performed to insure there is no tumor or mass in the cervix [24-26], and breast cancer exam has been done to verify that the breast has no clumps [27-29].

Samples collection and swim up technique

Semen has been collected in special sterile container that has the name, the time of collecting the samples from each patient alone. Semen was left in the incubator to turn into liquid. Semen analysis has been done, and then the semen was centrifugated at 2000 rpm/ 10 min to separate the sperm from the seminal plasma. The semen were aspirated away to get rid of sever cramping, while the sediment that contain the sperm were washed away by suspending with sperm washing pre-warmed media Fertipro flushing media [30, 31]. The mixture was centrifuged again, the supernatant was discarded and the sediment was resuspended in Fertipro gain media. The tubes were kept in the incubator at 37 C for 50-60 min. Later, the supernatant was collected with sterile pipette. Finally, the mixture transferred to Gynetic IUI catheter, and, it is ready to be used for IUI [32, 33].

In the end, the processed sperms were transported by sterile catheter into the females, where a small catheter is placed through the cervical OS to deliver sperm directly into the uterus, thus bypassing the cervical barrier [34].

Statistical analysis

GraphPad prism version 8 software for Windows, La Jolla California USA, www.graphpad.com, was performed in our project. Percentages compared to the expected results. Significant data symbolized by star as the following: 0.01 ≤ *p <0.05; 0.001 ≤ **p <0.01; ***p <0.001.

Results

As we stated in Tab. 1., the sperm concentration has lowered significantly, as our IUI methods collect only live and active sperm. On the other hand, we have noticed that the sperm vitality has increased significantly. For sperm activity, we have followed the WHO classification in of the sperm activity by using ABCD system. A is given when the sperm are moving forward fast in a straight line. B means the sperm swim forward in a curved line. C refers to sperm that moves its tail only. D means immotile sperm.

Tab. 1. Semen parameters before and after processing.

However, Fig. 1. is showing the number of successful cases in our research. As we see there is 80 cases Pregnant (Pr) of successful cases out of 200 women participated in the study (40%). By this we have 120 NPr Non pregnant cases (60%).

Fig. 1. Number of pregnant women.

Our findings have documented a significant relationship between the women age and the productive IUI rate (Tab. 2.).

Tab. 2. The role of age in having a successful IUI.

Discussion

Female infertility can result from a complex interplay of inflammatory, metabolic, and immune factors that disrupt normal reproductive function [35, 36]. Chronic inflammation often linked to conditions like endometriosis and pelvic inflammatory disease, can damage the reproductive organs, create scar tissue, and interfere with implantation. These inflammatory conditions trigger the release of cytokines and other immune mediators that impair ovulation and embryo development [37-39]. Metabolic disorders, particularly Polycystic Ovary Syndrome (PCOS), are major contributors to infertility due to hormonal imbalances, insulin resistance, and disrupted ovulatory cycles [40-42]. Obesity and diabetes, both metabolic in nature, further exacerbate hormonal dysregulation, negatively impacting egg quality and menstrual regularity [43-45]. Immune-related infertility occurs when the body's defense system mistakenly attacks reproductive tissues or sperm, as seen in autoimmune diseases like lupus or thyroid disorders. In some cases, the presence of antisperm or anti-ovarian antibodies disrupts fertilization and ovarian function. The immune system may also interfere with embryo implantation by rejecting the embryo as a foreign body. These factors are often intertwined; for example, metabolic imbalances can promote systemic inflammation, while chronic inflammation can trigger autoimmune responses [46, 47]. Diagnosis usually involves hormonal assays, imaging, and immune testing. Treatment depends on the underlying cause and may include anti-inflammatory drugs, hormonal therapy, lifestyle modifications, or immunosuppressive medications [48-50]. Addressing these root causes improves the chances of conception and a healthy pregnancy.

Sperm analysis was shown that the sperm concentration has lowered significantly. These results were expected as our methods collect the life and active sperm, while the dead and slow active sperm were discarded with centrifugation. Our methods were based on other groups of researchers with minor modification [51, 52]. Sperm swim up methods were seen as a good method in separating the active motile sperm. Our results have agreed with other researchers who have used the same methods [53, 54]. Fig. 1. has showed our successful work as we have gotten 80 pregnant cases so far. These cases tell us that the barrier for the pregnancy is in the cervical area and by using IUI we have overcome this obstacle successfully [55, 56]. However, we have 120 cases have not been conceived, but our percentages is similar to several research that have been done worldwide [57, 58]. Finally, we also have done hormonal analysis for all the participants, but we decided to publish them in a separate paper.

Conclusion

Using swim-up technique of semen processing activated the sperm and increase its vitality and this technique effect positively on pregnancy rate in female undergo IUI Moreover, female younger age play a role in IUI success.

Acknowledgement

The authors would like to acknowledge the High Institution for Infertility Diagnosis and Assisted Reproductive Technologies, Al- Nahrain University, Baghdad, Iraq. The authors also express their thankfulness to the College of Medicine, Thi-Qar University for the support provided to accomplish this study.

Ethics Approval

This research was conducted was conducted in accordance with the Declaration of Helsinki. This study was approved by the ethical committee of high institute for infertility diagnosis and assisted reproductive technologies, Al- Nahrain University, Baghdad, Iraq after evaluating the most recent installment, topic information, and research plan. An informed written/ oral consent was obtained from all participants.

Funding

There is no funding for this study.

Conflict of Interest

There are no conflict of interest interests to declare.

Author Contributions

Saba Sabeh Hussain conducted the investigation, wrote and refined the first draft of the document, participated in its design and provided financing and other forms of assistance. Muhjah Falah Hassan donated supplies, equipment, and finished the final copy of the research article. Safa Jihad created the theoretical framework for the researched project and specified the parameters of the exploratory analysis. Hayder Ridha-Salman outlined the main goals through an in-depth assessment of the findings and supplemented with insightful criticism and supervision.

Data Availability Statement

Data verifying the results of the research can be acquired from the corresponding author with an appropriate request.

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