Pregnancy rate improves in couples with unexplained infertilifty following intrauterine insemination (IUI) with magnetically selected non-apoptotic sperms

Abstract

To investigate the efficacy of non-aoptotic sperms (NAS) separated through magnetic activated cell sorting (MACS) in improving pregnancy rates in couples with unexplained infertility following IUI. Prospective randomized study. Sixty couples with primary, unexplained infertility were randomized to receive semen specimen for IUI for 3 cycles prepared through density gradient centrifugation (DGC) alone (n = 30) for control group (CG). The study group (SG) received (n = 30) NAS prepared following DGC through incubation with annexin V (AV) conjugated microbeads to retrieve AV negative, NAS fraction by application of MACS. The primary outcomes included: occurrence of pregnancy (biochemical or clinical) while the secondary outcomes were: ectopic pregnancy, miscarriage, caesarean section (C/S), twin pregnancy and live birth rate. An independent samples t test was used for comparisons, P value <0.05 was considered significant. INCLUSION CRITERIA: Sperm count ≥ 20 million/ml and male age < 40 yrs. Female normal baseline early hormonal assays, age < 35 with no uterine pathology. The occurrence of pregnancy was significantly higher in the SG (NAS) than CG (DGC): 40% (n = 12) vs.16.6% (n = 5). Live birth rates were 30% (n = 9) in SG vs. 13.3% (n = 4). There was higher incidence of C/S in SG: 20% (n = 6) vs. 3.3% (n = 1), P value 0.002. Miscarriage rate was 6.7% (n = 2) in the SG vs. 3.3% (n = 1). Ongoing pregnancy rates were substantially greater in the first IUI cycle in the SG (80%) in samples with higher sperm recovery. Live birth rate was more in SG with increased C/S rate vs. CG, P value < 0.0001. The utilization of MACS prepared NAS appears to be effective and safe in increasing the rate of conception in couples with un-explained infertility. The technique can be effectively adopted for assisted reproduction to increase success rates.