Our patient info about intrauterine insemination doesn't have anything about this, but it probably should. If you are scheduled for an intrauterine insemination using your husband's sperm (IUI-H), there is no reason to abstain from having sex during that cycle except for the night before the insemination. In fact, it might be bad to abstain. I saw a recent presentation claiming that IUI pregnancy rates are lower in couples who abstain for many days before the insemination.
MPS
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Hi there! One of my colleagues is a patient of yours. My husband and I are facing the conception process with a very low sperm count (3 million/ml). I do not know the volume. My question is this...is there a minimal number of sperm required to attempt IUI? Also, what can you tell me about cryo accumulation? I imagine we would have better chances if we had an accumulation of several samples with a wash on the day of IUI. Is this technique available and do you recomend it for couples like us? Any thoughts would be great. Thanks in advance.
p.s. if my husband's SA is no better on the second test, my OB will be referring us to you.
Gosh, these are great questions! Let's take them one at a time:
1. Minimal number of sperm for an IUI. In my opinion, there is no minimum number. As long as there are some motile sperm in the sample, I am up for doing an insemination. However, if the pre-wash sperm concentration is less than 1 million per ml, the pregnancy rate is quite low (I can't give you a meaningful number because there are too many other factors involved.) I wouldn't hesitate to do an IUI with a sample that has 3 million/ml.
2. Cryo accumulation. It sounds reasonable - store up a bunch of semen samples over several weeks and then thaw them all out at once for an insemination. This sort of thing has been tried for years, and to my knowledge, no one has ever documented any benefit, probably because the process of freezing and thawing the sperm reduces the ability of the sperm to function normally (which is probably why donor sperm pregnancy rates are lower with frozen sperm that with fresh sperm). It's not worth doing.
Here's the short version of how I deal with male infertility (and a 3 million/ml sperm concentration qualifies): (1) Repeat the semen analysis a time or two to make sure the first analysis wasn't a fluke (every guy can occasionally have a bad day). (2) Send the husband to a knowledgeable urologist for a physical exam and maybe some hormone testing.(3) If the urologist can't find anything to treat (and this is the case for about half the men), proceed with IUI for 3 or 4 cycles, and make sure the woman is ovulating (midluteal progesterone level) and has open tubes and a normal uterine cavity (HSG). If still no pregnancy after IUI and the semen analyses are clearly abnormal, proceed with IVF/ICSI (or go to donor insemination).
MPS
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