IUI-Know the details of anatomy of Reproductive system

Anatomy of male Reproductive System& IUI when ?? 

Anatomy of male Reproductive System.

The male reproductive organs consist of the tests and the accessory organs like epididymis , vas deferens, seminal vesicles ejaculatory duct, prostate gland and urethra. The supporting structures are the scrotum, penis and spermatic cords. The organs are involved  in the production and ejaculation of sperms and thus are closely related to fertility in the male.

Scrotum and Testes –The scrotum is a skin covered pouch suspended outside the abdominal cavity. It contains the testes, epididymis and spermatic cord. The temperature of the scrotum is maintained at 35c. this allows for optimal conditions for sperm production. If the temperature drops too low, the scrotal muscle contacts involuntarily to bring the testes closer to the heat of the body and vice versa. A high scrotal temperature does not affect testosterone production but spermatogenesis is impaired vesicles. It also stimulates the development of masculine secondary sex characteristics. Sertoli cells in the testes nourish the developing spermatozoa.

Vas Deferens –The vas deferens is an uncoiled duct that funnels the spermatozoa from the tail of the epididymis. The majority of the sperms are stored in the enlarged end of the vas deferens knows as the ampulla. If the sperm are not ejaculated , they soon degenerate and are adsorbed in these tubules.

Ejaculatory Ducts- The ampulla of the vas deferens combines with the duct from the seminal vesicle to from the ejaculatory ducts. The ejaculatory ducts are two short tubes that descend through the prostate gland to the urethra . From there the urethra passes out of the abdominal cavity and down the middle of the penis to the tip. The seminal vesicles are two saclike structures located within the peritoneal cavity and are lined with secretory epithelium that secrets viscous alkaline yellowish nutritive fluid. It mixes with sperm in the ejaculation of the sperm out of the urethra. On ejaculation the sperms become motile.

Normally 2 to 5 ml of the ejaculate is expelled from the body. The semen is a viscous milky fluid and normally contains millions of actively motile sperm.

The tests contain the tightly coiled seminiferous tubules. The seminiferous tubules are lined with that produces sperm. Approximately 2x 10 sperms are produced in the testes each that from the time of sexual maturity to old age. Interspersed  between the seminiferous tubules   of the testes are a number of interstitial cells called Leydig cells. These cells produced and secrete testosterone. Testosterone stimulated the pubertal  growth of the male genitalia, prostate and seminal vesicles.

SPERMATOGENESIS

The entire process       by    which     spermatogonial sperm cells divide and spermatozoa is known as follows :

1. Primordial undeveloped sperm cells divide and transform into spermatocytes.

2. Spermatocytes mature through several stages and then undergo cellular division so that their number of chromosomes is reduced from 46 to26 (meiosis).

3.The spermatocytes further divide and become ells known as spermatids.

4.The spermatids develop into spermatozoa. This process is called spermiogenesis during which the transforming cells are attached to the Sertoli cells.

5. After release from the Sertoil  cells the spermatozoa are stored in the epididymis where maturation continues.

6. The conversion of a spermatogonium into a fully different spermatozoon takes about 53 days .

7. Passage through epididymis ad vas deferens takes about 10 days.

Structure of spermatozoa

A single sperm is a microscopic motile germ cell that carries the male chromatin material. It consists of an oval head short neck and body. The head is almost entirely nuclear material rich in DNA and containing all the paternal genes. The tail is long and its motion causes the sperm to be actively motile. The mitochondria are found in the neck and supply the energy for the vigorous movement of the sperm.

Hormonal control of spermatogenesis

During puberty,  between the ages of 10 to 15 the anterior pituitary gland begins to secrete gonadotropic hormones under the influence of GnRH from hypothalamus. FSH initiates and maintains spermatogenesis by the tubules. LH causes secretion of testosterone by the interstitial cells. Testosterone inhibits LH secretion by acting directly on the anterior pituitary and by inhibiting the secretion of GnRH from the hypothalamus, inhibits FSH  secretion. In response to LH , some of the testosterone secreted from Leydig cells bathes the seminiferous epithelium and provides the high local concentration of androgen to the Sertoli cells that is necessary for normal spermatogenesis.

            INTRODUCTION TO IUI

Intra Uterine Insemination is one of the simple techniques of Assisted Reproductive Medicine treating infertility by artificial insemination. Insemination can be performed using the husband’s sperm or with sperm from a donor which is tested frozen quarantined and then re tested.

The therapy is relatively minimally invasive and an uncomplicated procedure. Execution of IUI is simple and doesn’t demand any special qualification.

In ART centers, IUI represents the first step of the therapy in the treatment of infertility. It is a cost effective, simple method which can be learnt easily.

Setup of an IUI laboratory is also within the reach of most gynecologists taking interest in infertility management.

IUI : What we as Gynaecologits need to be aware of ??

Point 1:-Why should we recommend the couple for IUI??  What is the success rate ? Success rate or Outcome  of IUI??  Ans:- It varies on cause of IUI. But the fact remains that Proper selection and well performed IUI results in pregnancy rates ranging between 5%-(oligozoospermia, Astnenozoospermia )  to 30% (coital problems ).

Point 2:-History of IUI: What was in two centuries back?? It was  John Hunter who was  credited with first report of successful insemination by semen from husband with hypospadias. In 1890 Dickinson first used artificial insemination with donor sperm in England. The first successful freezing of human semen was reported in 1953 by Bunge & Sherman.

Point 3:  Semen –where from?? Semen source ?

Semen is usually  taken from husband(coital problems, oligozoospermia, Astnenozoospermia or a donor depending upon the indication. All country & Committee  guidelines forbid the use of fresh semen from donors because of the fear of HIV .So, frozen semen can only be used after a quarantine period of 3-6 months.

What is te principle behind the   IUI Procedure??

a.  :In this process of IUI:- The procedure works in the following principle:- a)Selects most motile sperm fraction removing the debris and dead sperm.

b.  Removes prostaglandins present in high concentration in the seminal plasma and thus reduces the risk of uterine cramping.

c.   Removes infectious agents (organism/ bacteria ) and leucocytes.

d.  Removes antigenic proteins in the seminal plasma and thus improve prospects of fertility.

e.  Helps in the capacitation of spermatozoa.

f.     Sperm washing media provide nutritional support for the spermatozoa and keep their activity for longer time.

 What is being exactly achieved by carrying out the procedure of n  Intrauterine Insemination ?? 

a) Accurate timing with ovulation by serial follicular monitoring  b) Overcomes coital difficulties c) by passes the cervical mucous barrier which may be hostile to the sperm d) Increases the density of sperm in the upper genital tract. f)? The questionable indication is if the cervix is stenosed :-Overcomes anatomical cervical problems like stenotic cervix deviated or very kinked.

 IUI –What is being done?? The procedure itself:-Controlled Ovarian stimulation:

a.  Multiple ovulations expose spermatozoa to multiple oocytes for potential fertilization. Hopefully one ova will be fertilized  if there are two mature eggs released.

b.  Controlled ovulation induction corrects subtle ovulation defects.

c.   Better control over timing of ovulation.

INDICATIONS OF IUI

A) Suboptimal seminal parameter: density, Motility, Morphology

B)  variety of Male sexual disorders / Erectile / Premature Ejaculation’/ Ejaculatory disorders  failure to ejaculate /Delayed ejaculation /Anejaculation –vibrator method for ED if not cured by medicines & sex therapist.

C) Minimal endometriosis

D) Unexplained subfertility to maximize fertility per cycle 

E) Absent going to some other country-Migration-but wife reaming in own countryà