SDF is correlated with poor embryo development, implantation, and ongoing pregnancy rates. Reducing DNA fragmentation index (DFI) in the sample used for insemination may improve IVF outcomes. Prospective study to compare different sperm preparation techniques on the same semen sample to determine which methods most effectively improves DFI and other sperm health biomarkers, oxidative stress adducts (OSA) and high DNA stainability (HDS) index. Thirty samples from semen analysis patients were obtained. Samples sent to ReproSource (Woburn, MA) were blinded by freezing the samples in vials labeled with a random number. An aliquot of 0.3 mL of neat semen was frozen and the remainder of the semen allocated between 5 preparation methods (1-5). A sterile syringe was used to load 0.8 mL of raw semen in ZyMōt Sperm Separation Device (1,DxNow) then layered with G-IVF+ and incubated for 30 minutes. At the end of incubation, 0.3 mL of sperm was removed from the out port and frozen. Approximately 0.8 mL of semen was layered over the Isolate gradient (2,Irvine) and SpermGrad gradient (3,Vitrolife) per package insert and centrifuged for 15 minutes. The samples were reconstituted with GIVF+ and an aliquot of each was frozen. The pellet was re-formed and the tube incubated at an angle to obtain the swim-up (SU) Isolate + SU (4) and Spermgrad + SU (5), for each gradient. After one hour, an aliquot from the top of the top of the tube was frozen. Each blinded sample, 6 per semen sample, was analyzed using the Sperm DNA Fragmentation Assay (acridine orange/flow cytometry SDFA™) and the OSA™ test which directly measures sperm damage from oxidative stress by quantifying the presence of “adducts,” molecules in semen covalently modified by free radicals/reactive oxygen species. Statistical analysis was performed in JMP (SAS 2017). The mean age of men in the study was 37±8.3 years. Neat sperm concentrations ranged from 7 to 104 million/mL with 23.3% oligospermic. The motility of the samples ranged from 15 to 80% motility with an average of 52.2±16.9%. DFI, OSA, and HDS were compared between preparation methods on the same ejaculate using Wilcoxon Rank Sums between each pair with P<0.05 considered significant (See table).Tabled 1Prep Method 1Prep Method 2DFI p-valueOSA p-valueHDS p-valueNeatIsolate0.00520.00020.0011NeatIsolate + SU0.00230.0002<0.0001NeatSpermGrad0.0740.05740.2837NeatSpermGrad + SU0.01840.00240.0002NeatDxNow<0.0001<0.0001<0.0001IsolateIsolate + SU0.67890.83600.0389IsolateSpermGrad0.37500.06560.0326IsolateSpermGrad + SU0.65200.73940.1808IsolateDxNow<0.00010.0657<0.0001SpermGradSpermGrad + SU0.44640.31830.0044SpermGradIsolate + SU0.17610.06560.0005SpermGradDxNow<0.00010.0004<0.0001DxNowIsolate + SU<0.00010.0224<0.0001DxNowSpermGrad + SU<0.00010.0428<0.0001SpermGrad + SUIsolate + SU0.47790.97640.0044DFI, OSA, and HDS were compared between preparation methods on the same ejaculate using Wilcoxon Rank Sums between each preparation method. Open table in a new tab DFI, OSA, and HDS were compared between preparation methods on the same ejaculate using Wilcoxon Rank Sums between each preparation method. Sperm preparation methods have changed very little even with the rapid advances in the IVF laboratory. The sperm separation device is a novel method that effectively reduced DFI (p<0.0001) compared to two different gradients (2,3) and gradients followed by swim-up (4,5). The device also has eliminated centrifugation, a step known to increase oxidative stress. The device reduced OSA levels, a measurement of oxidative stress, and HDS, which is a measurement of immature cells and high histone retention. These are both indicators of sperm health and function. Overall, the quality of the sperm obtained post-processing was improved by the use of the separation device, which may increase the chance of a healthy sperm being used for fertilization.
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