Srinivas Sangisapu1, Sandeep Karunakaran2, Ashok Kumar Pillai3
Recovery of optimum number of good quality of spermatozoa is an important component of In Vitro Fertilisation (IVF). This is achieved by sperm preparation methods involving separation and recovery of capacitated sperms. Double Wash Swim-up (DWSU) and Double Density Gradient Swim-up (DDGSU) are two most accepted methods. Cochrane systematic review (2007) finds no clear benefit of one method over the other in Intrauterine Insemination (IUI). Systematic review on effectiveness of these preparations in IVF is lacking. Effectiveness is generally assessed in terms recovery rates of the sperms. Capability of successful fertilisation of good quality oocytes should ideally be the functional endpoint for evaluating effectiveness of sperm preparation methods.
The aim of the study is to-
1. Compare the successful fertilisation rates of oocytes inseminated by semen preparation of Double Wash Swim-up (DWSU) vis-a-vis by Double Density Gradient Swim-up (DDGSU) method.
2. Evaluate the effectiveness of fertilisation of oocytes by Double Wash Swim-up method (DWSU) vis-a-vis Double Density Gradient Swim-up (DDGSU) method.
MATERIALS AND METHODS
A retrospective cohort study was conducted on infertile couples undergoing IVF from June 2014 to June 2017 at an ART Centre of a tertiary care hospital. The male partners were normozoospermic and female partners were normoresponsive to controlled ovarian stimulation and oocyte retrieval.
70 male partners were subjected to double wash swim-up and 64 underwent double density gradient swim-up preparation. 1296 good quality oocytes were retrieved in their respective female partners. 452 (61%) out of 742 oocytes were successfully fertilised after insemination by semen prepared by DWSU method. 378 (68%) oocytes out of 554 were fertilised by insemination with semen prepared by DDGSU method. There seems to be strong association (RR=1.12) of fertilisation success with oocytes exposed to semen prepared by Double Density Gradient Swim-up (DDGSU), which is statistically significant (p=0.007) from the Double Wash Swim-up (DWSU) method.
Double density gradient swim-up method of sperm preparation seems to be strongly associated with successful fertilisation of oocytes and is statistically, significantly different from that of double wash swim-up method. Further, more prospective randomised controlled study is desirable to arrive at good quality of evidence to assess the effectiveness of both the methods of semen preparation.