Abstract
Genetically normal, structurally intact and mature sperm is desired for ICSI to achieve optimum outcome in an ART cycle. Various strategies to select the best sperm include selection based on surface charge; sperm birefringence; ability to bind to hyaluronic acid; and evaluate morphology under ultra-high magnification. A few published reports indicated that injection of hyaluronan bound sperm can significantly improve pregnancy rate. However, Cochrane Database Syst Rev. 2014 Oct 28;10:CD010461 found insufficient evidence of increased efficacy of hyaluronic acid binding method (PICSI dish). The objective of this study was to compare oocyte fertilization, day-3 embryo quality and pregnancy rate between conventional ICSI and PICSI dish. Retrospective study analyzing data from years 2014 and 2015 at a busy ART Clinic. Ovarian stimulation, oocyte retrieval, denudation, embryo culture and other procedures were performed following standard protocols. The PICSI dishes were used for 145 couples and conventional ICSI dishes for 148 patients of similar age and infertility diagnosis receiving treatment during the same time period. Sperm parameters were similar in both groups. Couples with abnormal sperm parameters and extremely poor oocyte quality were excluded. The parameters compared were; fertilization rate, day-3 embryo development and pregnancy rate for couples yielding less than 5, 5-10 and more than 10 oocytes. Data were calculated as Mean ± SD. Comparisons between 2 study groups are shown in Table 1. The fertilization rate was calculated based on number of MII oocytes. The overall age, % fertilization and > 5 cells grade 1 or grade 2 embryos were not different between 2 groups. Percent pregnancy rate for the conventional ICSI (40%) was not different from that of PICSI (39.34 %). The semen volume (mL), sperm concentration (M/mL) and % motility were; 2.9 ± 1.3, 51 ± 40 and 46 ± 21 for ICSI group and 3 ± 1.4, 64 ± 45 and 56 ± 16 for PICSI group, respectively.Tabled 1Table 1Comparison between conventional ICSI and PICSI parametersOocytesAge yrs(ICSI)Fertilization ICSI %D-3 Embryos ICSI %Age yrs(PICSI)Fertilization PICSI %D-3 Embryos PICSI %<539.8 ± 4.389 ± 1080.8 ± 3236 ± 381 ± 2078 ± 285 to 1036.5 ± 5.376 ± 1878 ± 2836 ± 573 ± 2372 ± 28> 1033 ± 4.769 ± 1571 ± 2735 ± 471 ± 1770 ± 24Overall34.6 ± 5.372 ± 1773.6 ± 2835 ± 4.373 ± 2070 ± 26 Open table in a new tab These data indicated that use of PICSI dishes did not improve fertilization rate, number of > 5 cells grade 1 or 2 embryos on day-3 or the pregnancy rate in couples suffering from non-male factor infertility. Further prospective controlled studies are required to evaluate whether PICSI sperm selection significantly increases ART cycle outcome.
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