Evaluating the feasibility of low cost sperm preparation methods within a prospective intrauterine insemination program in Gabon

Abstract

Introduction: Intrauterine insemination (IUI) is frequently used as the first-line treatment for infertility, due to the relative simplicity and cost-effectiveness of the procedure. Even though, several sperm processing techniques are used for IUI, semen samples need to be washed using a single and appropriate method prior to insemination. Implementing low-cost sperm preparation methods for IUI would benefit those seeking help in developing countries such as Gabon, where treatment for infertility is currently virtually non-existent. The first section of this research was aimed towards the evaluation of a sperm swim-up method (SW-10) while in the second section the feasibility of establishing an IUI programme in Gabon was explored. Methods: The initial section involved three sets of experiments. Semen samples were obtained from patients and donors participating in the Reproductive Biology Laboratory?s research donor registry programme. For experiment (i), semen samples (n=25) were divided into 3 equal aliquots and processed using three syringes with volumes of 5 ml (SW-5),10 ml (SW-10) and 20 ml (SW-20), respectively. During experiment (ii), semen samples (n=20) were split into 2 equal volumes and processed using either the SEP-D kit or the SW-10 method. In experiment (iii) (n=20) two sperm preparation methods i.e. the single layer centrifugation (SLC) and the density gradient centrifugation (DGC) were compared. For post-processing analyses, concentration, motility and total motile sperm count (experiments (i), (ii) and (iii)), as well as morphology, viability and DNA integrity (experiment (ii)) were evaluated. Information on the feasibility of establishing an IUI programme in Gabon in the second section was obtained from a questionnaire completed by gynaecologists practising in Gabon. Results: In the first section, experiment (i) indicated a significant increase in motility and concentrations in spermatozoa processed using the SW-10 method when compared to SW-5 and SW-20 (p<0.05). Experiment (ii) revealed that the SW-10 method yielded spermatozoa with significant superior motility and concentration when compared to that obtained using the SEP-D kit (p<0.05). The SW-10 yielded a statistically significant larger number of spermatozoa with intact plasma membranes, DNA content and normal morphology (p<0.05). In experiment (iii), semen processed using SLC resulted in spermatozoa with statistically significant higher concentrations. However spermatozoa obtained from the DGC had superior motility. The second section comprised a gynaecological survey conducted in Gabon. Seventeen (85%) of the 20 registered gynaecologists participated in the survey. Gynaecologists were particularly interested in a basic infertility treatment and training programme, as well as in the establishment of an ART unit in Libreville. All participants were in agreement that ART services would improve both diagnostic and therapeutic patient services in Gabon. Discussion and conclusion: This study indicated that spermatozoa recovered from the simplified sperm swim-up method had statistically significantly higher sperm parameters when compared to those from the SEP-D kit. Processing semen using SLC resulted in significantly higher sperm concentration when compared to that of the DGC, which yielded a higher percentage of progressively motile spermatozoa. The need to establish an IUI programme in Gabon was proved in the second section of this study. In conclusion, the simplified swim-up method can possibly be an effective low-cost alternative in the preparation of semen samples for IUI procedures. The implementation of low-cost sperm preparation methods can be important in developing countries such as Gabon.