Clinical outcome using non-apoptotic sperm selection for ICSI procedures: report of 1 year experience

Abstract

OBJECTIVE: To evaluate the use of non-apoptotic sperm selection by MACS (Magnetic Activated Cell Sorting) on the clinical outcome of ICSI.DESIGN: Retrospective study.MATERIALS AND METHODS: MACS has been used in 172 patients with at least one ICSI without pregnancy and high levels of active caspase-3 and/or sperm DNA fragmentation assessed by TUNEL inmunocytochemistry diagnosis. Selected patients were separated in 2 groups. Group 1 : (n= 106 cycles) females ≤37 years old and >3 MII oocytes retrieved, Group 2 : (n= 68 cycles) females >37 years old and/or ≤ 3 MII oocytes retrieved. In order to evaluate the sperm factor using MACS reducing the oocyte quality influence, Group 1 was subdivided in 3 subgroups considering the apoptosis markers A) TUNEL ≥20%, B) active caspase-3 ≥11% and C) both altered. After signing an informed consent, semen samples were prepared by two gradient layers (90-45%). The resulting pellet was then used for sperm separation with MACS according to the manufacturer. The eluted fraction was used for sperm injection. Fertilization rates (FR), embryo quality (EQ), pregnancies rates (PR), implantation rates (IR), miscarriages rates (MR) were evaluated. Chi-square and Student's t-tests were performed for statistics analysis.RESULTS: There was statistic significant difference in PR (33.9% vs. 5.9%) and IR (21.9 % vs. 4.3%) between both groups (p<0.05). A better overall EQ was observed in Group 1 (p<0.05). However the FR and MR do not showed significant differences. Considering the sperm apoptosis status, interestingly subgroups A, B and C do not showed significant differences in achieving pregnancies and embryo quality.CONCLUSION: Results suggest that the use of MACS improve embryo quality, implantation and pregnancies rates in patients with high levels of active caspase-3 and/or sperm DNA fragmentation. Finally remark that the increase in pregnancy rates would be related to the improvement in sperm quality (by MACS) associated with good quality oocytes. OBJECTIVE: To evaluate the use of non-apoptotic sperm selection by MACS (Magnetic Activated Cell Sorting) on the clinical outcome of ICSI. DESIGN: Retrospective study. MATERIALS AND METHODS: MACS has been used in 172 patients with at least one ICSI without pregnancy and high levels of active caspase-3 and/or sperm DNA fragmentation assessed by TUNEL inmunocytochemistry diagnosis. Selected patients were separated in 2 groups. Group 1 : (n= 106 cycles) females ≤37 years old and >3 MII oocytes retrieved, Group 2 : (n= 68 cycles) females >37 years old and/or ≤ 3 MII oocytes retrieved. In order to evaluate the sperm factor using MACS reducing the oocyte quality influence, Group 1 was subdivided in 3 subgroups considering the apoptosis markers A) TUNEL ≥20%, B) active caspase-3 ≥11% and C) both altered. After signing an informed consent, semen samples were prepared by two gradient layers (90-45%). The resulting pellet was then used for sperm separation with MACS according to the manufacturer. The eluted fraction was used for sperm injection. Fertilization rates (FR), embryo quality (EQ), pregnancies rates (PR), implantation rates (IR), miscarriages rates (MR) were evaluated. Chi-square and Student's t-tests were performed for statistics analysis. RESULTS: There was statistic significant difference in PR (33.9% vs. 5.9%) and IR (21.9 % vs. 4.3%) between both groups (p<0.05). A better overall EQ was observed in Group 1 (p<0.05). However the FR and MR do not showed significant differences. Considering the sperm apoptosis status, interestingly subgroups A, B and C do not showed significant differences in achieving pregnancies and embryo quality. CONCLUSION: Results suggest that the use of MACS improve embryo quality, implantation and pregnancies rates in patients with high levels of active caspase-3 and/or sperm DNA fragmentation. Finally remark that the increase in pregnancy rates would be related to the improvement in sperm quality (by MACS) associated with good quality oocytes.