PICSI vs. MACS for abnormal sperm DNA fragmentation ICSI cases: a prospective randomized trial.

Eman Hasanen,Ralf Henkel,Salma Eltanbouly,Khaled Elqusi,Abd Elghafar Hussin,Hanaa Alkhadr,Ashok Agarwal,Hosam Zaki

doi:10.1007/s10815-020-01913-4

Abstract

To know which sperm selection technique, physiological intracytoplasmic sperm injection (PICSI) or magnetic-activated cell sorting (MACS), is better for the selection of sperm with abnormal sperm DNA fragmentation (SDF) in patients undergoing intracytoplasmic sperm injection (ICSI). A prospective randomized trial included 413 ICSI cases with abnormal SDF (> 20.3%) by TUNEL assay. Patients with at least 1 million total progressive motile sperm count were randomized to PICSI or MACS groups on the day of ICSI. PICSI depends on the hyaluronan binding of better SDF sperm where individual sperm was selected, while MACS selects non-apoptotic sperm population using Annexin V magnetic beads. All pre-implantation embryogenic parameters were observed and the main outcome was the ongoing pregnancy rate. There were no significant differences between patients allocated to PICSI and MACS in the studied parameters including pre-implantation embryological data, implantation, clinical pregnancy, and ongoing pregnancy rates. Meanwhile, sub-analysis according to the female age has shown that female patients with less than 30years of age in the MACS group had significantly higher good-quality blastocyst, clinical pregnancy, and ongoing pregnancy rates than the PICSI group. However, the higher implantation (p = 0.051), clinical pregnancy (p = 0.078), and ongoing pregnancy (p = 0.097) rates observed in females between 30 and 35years of age in the PICSI group did not reach significance level. PICSI and MACS are efficient techniques for sperm selection in cases with abnormal sperm DNA fragmentation. However, MACS is preferred when the females are younger than 30years, while PICSI is preferred in older females. NCT03398317 (retrospectively registered).

Highlights

The number of couples seeking infertility treatment is steadily increasing [1]
magneticactivated cell sorting (MACS) is preferred when the females are younger than 30 years, while physiological intracytoplasmic sperm injection (PICSI) is preferred in older females
396 couples were included in the analysis PICSI (n = 200) and MACS (n = 196)

Summary

Introduction

The number of couples seeking infertility treatment is steadily increasing [1]. Infertility affects about 10–15% of couples worldwide [1] and 30–50% of the cases show a paternal cause of infertility which may negatively affect the reproductive outcomes [2, 3]. The management of male infertility can be Cleveland, OH, USA through treating the underlying causes or using a suitable assisted reproductive technique like intracytoplasmic sperm injection (ICSI) [2]. Sperm DNA fragmentation (SDF) is suggested to be a major factor of male infertility [7,8,9] that negatively affects fertilization [10], cleavage [10], blastulation [9, 10], implantation [11], clinical pregnancy [8, 9], miscarriage [11,12,13], and live birth rates [7] after in vitro fertilization (IVF) and ICSI. There are indications that oocytes can repair sperm DNA damage to a certain extent [14, 15] depending on the oocyte quality, degree of sperm DNA fragmentation, and time needed for repair [15]

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