The Impact of Magnetic Activated Cell Sorting (MACS) on Assisted Reproduction Outcomes

Abstract

Objectives The study’s objectives were to evaluate the benefits of adding the magnetically activated cell sorting (MACS) technique to the traditional density gradient sperm wash method for advanced sperm selection in intracytoplasmic sperm injection (ICSI) cycles by comparing fertilisation rates, embryo quality, blastocyst formation, and pregnancy rates. Material and Methods A retrospective observational study was conducted at ARMC Aegis Hospital Perinthalmanna, Kerala. The study group was 116 patients taken during ICSI cycles done from October 2021 to September 2023, with 58 patients in the study (MACS after density gradient centrifugation) and 58 in control (density gradient centrifugation alone). Cases and controls were determined by the willingness of the patient to do MACS in sperm selection after discussion with their clinician. Patients with a severe male factor with sperm morphology <4% were included in the study, with the female partner having regular cycles, normal AFC, and AMH > 1 ng/ml. Patients with seminal infection, known genetic errors, female partners with endometriosis, PCOS, infections, malformations and previous poor responders were excluded. Spermatozoa are incubated with microbeads for 15 min at room temperature (100 μl/10 million) in MACS, after which they are placed into a separation column that contains magnetised iron spheres in it that is magnetised. While the unlabelled cells flow through the MACS column, the micro-bead labelled cells are trapped there subsequently, ICSI was performed using the processed sperm sample. The 2PN (Pro-nuclei) embryos, blastocysts, embryo quality, clinical pregnancies, and live births were noted and statistically analysed. Results The study and control groups were demographically similar; both cases (MACS group) and control group Density Gradient Centrifugation (DGC) group were under a 95% confidence interval. Results of the MACS group were compared with the DGC group. 2 PN status, number of embryos, Grade I embryos, day 5 blastocyst formation, live birth rates, and the number of positive pregnancies were examined in both groups. Analysis showed an increase in the 2 PN status, number of embryos, Grade I embryos, and day 5 blastocyst formation in the MACS group compared to the conventional DGC method. However, embryo grades (Grade I embryos) in the MACS group were high compared to the DGC group (P-value < 0.01). Conclusion For couples with severe male factors and defective sperm morphology, the study finds that MACS may be recommended as an additional option to standard sperm processing.