Physiological Intracytoplasmic Sperm Injection Research Articles

Comparison of the effects of sperm selection methods on assisted reproduction outcomes in male infertility

Objective: To compare physiological intracytoplasmic sperm injection (PICSI) and the hypoosmotic swelling test (HOST) sperm selection techniques in terms of embryo development, implantation rate and live birth rates in cases of severe or moderate oligoastheneospermia. Materials and Methods: The electronic material and files of cases admitted to the Medipol University IVF Centre between 2013 and 2022 were analyzed retrospectively. This research included a total of 143 cases with moderate or severe oligoasthenospermia, 80 cases with PICSI as sperm selection technique and 63 cases with HOST as sperm selection technique. Cases of severe or moderate oligoasthenospermia as defined by the World Health Organisation (WHO) are included in this study. The demographic parameters of both groups, including female age, paternal age, duration of infertility, AMH (anti-Mullerian hormone), body mass index (BMI), endometrial thickness, and the number of prior attempts, were analyzed. Implantation, pregnancy loss, and rates of live births were compared between two groups. Results: Female age, paternal age, AMH, endometrial thickness, BMI, and the number of previous trials were similar between the groups included in the study. There were not any significant differences between the groups in terms of fertilization (.18±6.92 vs 9.11±6.35, p=0.345), TQ-GQ blastocyst development (2.36±2.40 vs 1.64±2.35, p=0.097), and the number of embryos transferred (1.59±0.50 -1.76±0.44 p= 0.141). The live birth rates between the PICSI and HOST groups did not vary statistically (p=0.790), however, the rate of implantation was significantly higher in the HOST group (p=0.043). Sperm selection by PICSI or HOST method did not affect fertilization, TQ-GQ blastocyst development, and the rates of pregnancy loss and live birth. Conclusion: Although there were not any differences in embryo development, pregnancy loss, and live birth rates comparing the two methods, the HOST group had a higher implantation rate. Keywords: PICSI, HOST, Male infertlity, live birth

Physiological intracytoplasmic sperm injection does not improve the quality of embryos: A cross-sectional investigation on sibling oocytes.

This study aimed to compare the efficacy of physiological intracytoplasmic sperm injection (PICSI) and intracytoplasmic sperm injection (ICSI) in terms of the fertilization rate and embryo quality using sibling oocyte cycles. This prospective, cross-sectional study collected data from 76 couples who underwent their first cycle at the Hue Center for Reproductive Endocrinology and Infertility, Vietnam, between May 2019 and November 2021. The inclusion criteria were cycles with at least eight oocytes and a sperm concentration of 5×106/mL. Sperm parameters, sperm DNA fragmentation (SDF), fertilization, and the quality of cleavage-stage embryos on day 2 and blastocysts on day 5 were examined. From 76 ICSI cycles, 1,196 metaphase II (MII) oocytes were retrieved, half of which were randomly allocated to either the PICSI (n=592) or ICSI (n=604) treatment group. The results showed no significant difference between the two groups in terms of fertilization (72.80% vs. 75.33%, p=0.32), day 2 cleavage rate (95.13% vs. 96.04%, p=0.51), blastulation rate (52.68% vs. 57.89%), and high-quality blastocyst rate (26.10% vs. 31.13%, p=0.13). However, in cases where SDF was low, 59 cycles consisting of 913 MII oocytes produced a considerably higher blastulation rate with PICSI than with ICSI (50.49% vs. 35.65%, p=0.00). There were no significant differences between the pregnancy outcomes of the PICSI and ICSI embryo groups following embryo transfer. Using variable sperm quality provided no benefit for PICSI versus ICSI in terms of embryo outcomes. When SDF is low, PICSI appears to be able to produce more blastocysts.

Influence of a hyaluronan-binding system for sperm selection in intracytoplasmic sperm injection cycles on embryo morphokinetic parameters and in vitro fertilization cycle outcomes.

Although the impact of the paternal contribution to embryo quality and blastocyst formation is a well-known phenomenon, the current literature provides insufficient evidence that hyaluronan-binding sperm selection methods improve assisted reproductive treatment outcomes. Thus, we compared the cycle outcomes of morphologically selected intracytoplasmic sperm injection (ICSI) with hyaluronan binding physiological intracytoplasmic sperm injection (PICSI) cycles. A total of 2415 ICSI and 400 PICSI procedures of 1630 patients who underwent in vitro fertilization cycles using a time-lapse monitoring system between 2014 and 2018 were analyzed retrospectively. Fertilization rate, embryo quality, clinical pregnancy rate, biochemical pregnancy rate and miscarriage rate were evaluated, differences in morphokinetic parameters and cycle outcomes were compared. In total, 85.8 and 14.2% of the whole cohort were fertilized with standard ICSI and PICSI, respectively. The proportion of fertilized oocytes did not significantly differ between groups (74.53 ± 1.33 vs. 72.92 ± 2.64, p > 0.05). Similarly, the proportion of good-quality embryos according to the time-lapse parameters and the clinical pregnancy rate did not significantly differ between groups (71.93 ± 4.21 vs. 71.33 ± 2.64, p > 0.05 and 45.55 ± 2.91 vs. 44.96 ± 1.25, p > 0.05). No statistically significant differences were found between groups in clinical pregnancy rates (45.55 ± 2.91 vs. 44.96 ± 1.25, p > 0.05). Biochemical pregnancy rates (11.24 ± 2.12 vs. 10.85 ± 1.83, p > 0.05) and miscarriage rates (24.89 ± 3.74 vs. 27.91 ± 4.91, p > 0.05) were not significantly different between groups. The effects of the PICSI procedure on fertilization rate, biochemical pregnancy rate, miscarriage rate, embryo quality, and clinical pregnancy outcomes were not superior. The effect of the PICSI procedure on embryo morphokinetics was not apparent when all parameters were considered.

#ESHREjc report: are sperm selection techniques a panacea? Indications for the use of physiological intracytoplasmic sperm injection (PICSI) in medically assisted reproduction

#ESHREjc report: are sperm selection techniques a panacea? Indications for the use of physiological intracytoplasmic sperm injection (PICSI) in medically assisted reproduction

Comparison of the Efficiency of Magnetic-Activated Cell Sorting (MACS) and Physiological Intracytoplasmic Sperm Injection (PICSI) for Sperm Selection in Cases with Unexplained Infertility.

The cases with unexplained infertility may have an abnormality in their sperm chromatin structure. Sperm selection methods can be used to separate sperm with low DNA fragmentation. The purpose of this study was to compare the efficacy of physiological intracytoplasmic sperm injection (PICSI) with magnetic-activated cell sorting (MACS) in assisted reproductive techniques in cases with unexplained infertility. The semen samples were collected from couples with unexplained infertility. After semen analysis and sperm DNA fragmentation (SDF) evaluations, samples were prepared with swim-up method. The rates of SDF in different fractions including raw semen (n=20), swim-up (n=20), only motile sperm after swim-up (swim-up selection) (n=20), MACS sperm selection (n=20), only motile sperm after MACS (MACS selection) (n=20), and PICSI sperm selection (n=16) were evaluated. Also, the main sperm characteristics and fine morphology of sperm suspension after MACS were assessed. Statistical analysis was performed using GraphPad Prism. The p<0.05 was considered statistically significant. DNA fragmentation index (DFI) values in PICSI and MACS groups were significantly reduced as compared to the swim-up group. The rate of this reduction was more pronounced in MACS (58.20±13.02) than PICSI (36.57±15.52) group. Also, our results showed that MACS resulted in decreased sperm motility, with no alteration in their fine morphology. MACS was found to be more efficient in reduction of SDF rates than PICSI. However, none of the sperm selection techniques can not totally eliminated the spermatozoa with DNA fragmentation in the final sperm sample.

P-070 Comparison of Microfluidic Sperm Sorting (MFSS) versus Physiological Intracytoplasmic Sperm Injection (PICSI) versus Density Gradient versus Swim Up in high DNA fragmentation index sperm samples

Abstract Study question To evaluate the effectiveness of using Microfluidic Sperm Sorting (MFSS) over other technique in patient with high DNA fragmentation index (DFI) sperm samples? Summary answer Microfluidic is not only correlated with better DNA integrity but also with the better reproductive outcome. What is known already DNA damage is unrecognisable in living sperm prior to insemination and an increased sperm DNA fragmentation index has been associated with lower fertilization rates, impaired embryo development and reduced pregnancy rates. Standard semen processing techniques are associated with centrifugation, which may induce reactive oxygen species and DNA damage. In strategies to minimize sperm DNA fragmentation, Physiological ICSI can relatively reduce sperm DNA fragmentation by 67.9% (Parmegiani et al., 2010) while new technique Microfluidic sperm sorter technique also demonstrate sperm selection with significantly reduced DNA damage Study design, size, duration A prospective randomised study was conducted from 1st January 2019 to 1st December 2021. Four hundred patients were randomised by computer generated list and divided into 4 groups. Group A (n = 100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n = 100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI), Group C (n = 100), sperm were processed by density gradient and Group D (n = 100), sperm were processed by swim-up technique. Participants/materials, setting, methods The study period included all normozoospermic patients with high DNA fragmentation index (&amp;gt;25%) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. All the 3 groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate, clinical pregnancy rate and miscarriage rate. Main results and the role of chance Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar among all 4 groups. Among 4 groups, There was a statistically significant increase observed in Group A (Microfluidic Sperm Sorting), day 3 grade A embryo development rate (60% vs. 42% vs. 38% vs. 40%, p-0.016) and clinical pregnancy rate (62% vs. 46% vs. 41% vs 43%, p-0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78% vs. 76% vs. 78%, p-0.80) comparing group B, group C and group D. But significantly higher miscarriage rate (12% vs. 11% vs. 25%, 12%) observed in density gradient (Group C) technique. Limitations, reasons for caution Larger randomised control studies are needed to strengthen these results. Wider implications of the findings We have demonstrated that sperm sorted by microfluidic helps in selection of sperm with better DNA integrity over Physiological ICSI, Density Gradient and Swim-up techniues. Using it in routine practice can help in reducing the negative effect of reactive oxygen species and thus improve pregnancy rate and live birth rate. Trial registration number MCDH/2019/35

Comparison of zeta potential and physiological intracytoplasmic sperm injection in obtaining sperms with a lower DNA fragmentation index: A cross-sectional study.

BackgroundThe sperm DNA fragmentation index (DFI) is one of the men's reproductive health criteria that affects assisted reproductive technique outcomes. Efforts in obtaining high-quality mature sperms seem to be necessary. Advanced sperm selection techniques (including physiological intracytoplasmic sperm injection [PICSI], zeta potential, microfluidic, etc.) have gained popularity in this regard.ObjectiveThe study aimed to compare the efficacy of zeta potential and PICSI sperm selection in obtaining sperms with better DNA integrity.Materials and MethodsIn this cross-sectional study, 48 couples were enrolled where the male partner had increased sperm DFI in his ejaculated sample and the female was in normal reproductive health. For each male partner, the semen sample was processed with zeta potential and PICSI techniques, then the sperm DFI of neat semen was compared to zeta and PICSI samples by the sperm chromatin dispersion test.ResultsData showed that both the zeta potential and PICSI technique decreased sperm DFI in comparison with the neat semen sample (p 0.001 for both). In addition, there was a statistically significant difference in sperm DFI between the PICSI and zeta potential samples (p 0.01).ConclusionThe current study showed that both zeta potential and PICSI could result in sperm with a lower DFI. However, PICSI seems to be superior to zeta potential in this regard.

Sperm selection with hyaluronic acid improved live birth outcomes among older couples and was connected to sperm DNA quality, potentially affecting all treatment outcomes.

Sperm selection with hyaluronic acid improved live birth outcomes among older couples and was connected to sperm DNA quality, potentially affecting all treatment outcomes.

The efficacy of add-ons: selected IVF "add-on" procedures and future directions.

Since the advent of ART, technology has continuously evolved to improve embryology and pregnancy outcomes. However, not all technologies that are integrated into practice have convincing evidence of clinical effectiveness, and they often increase the financial burden of fertility care. We discuss here a selection of commonly utilized IVF "add-ons" and discuss the existing evidence for their utility. The procedures included in this review are time-lapse imaging of embryos, assisted hatching, EmbryoGlue, sperm DNA testing, egg activation with calcium ionophore, endometrial receptivity array, and physiological intracytoplasmic sperm injection (PICSI). While there is rather limited supporting evidence for nearly all IVF add-ons that we reviewed, there is strong demand from patients, physicians, and the biotechnology industry to continue further research and development in this arena. We propose that all add-on procedures should provide true efficacy for the patient, and reproductive endocrinologists should inform patients of the costs and benefits of utilizing various technologies before they undergo treatment. In the future, add-ons that show clear evidence of efficacy and justifiable cost should be incorporated into routine practice, while others that do not meet these criteria should be phased out entirely.

COMPARISON OF MICROFLUIDIC SPERM SORTING (MFSS) VERSUS PHYSIOLOGICAL INTRACYTOPLASMIC SPERM INJECTION (PICSI) VERSUS DENSITY GRADIENT IN HIGH DNA FRAGMENTATION INDEX SPERM SAMPLES

To evaluate the best method for sperm separation in high DNA fragmentation index (DFI) sperm samples. A prospective randomised study was conducted from 1st January 2019 to 1st January 2021. Three hundred patients were randomised by computer generated list and divided into 3 groups. Group A (n=100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n=100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI) technique and Group C (n=100), where sperm were processed by density gradient technique. Morphologically normal motile sperm were injected by Intracytoplasmic sperm injection (ICSI) technique in mature oocytes after all three techniques. The study period included all normozoospermic patients with high DNA fragmentation index (>25% ) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. All the 3 groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate , clinical pregnancy rate and miscarriage rate. Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar among all 3 groups. Between the 3 groups, there was a statistically significant increase observed in Group A (Microfluidic Sperm Sorting) in the day 3 grade A embryo development rate (60% vs. 42% vs. 38%, p-0.016) and clinical pregnancy rate (62% vs. 46% vs. 41%, p-0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78% vs. 76%, p-0.80) comparing with group B and group C. But significantly higher miscarriage rate ( 12% vs. 11% vs. 25%, p-0.019) observed in density gradient (Group C) technique. We have demonstrated that sperm sorted by microfluidic is not only correlated with better DNA integrity but also with the reproductive outcome. Using it in routine practice can help in reducing the extraneous affect of sperm processing techniques and achieving higher pregnancy rate and sustaining it comparing with PICSI and Density Gradient techniques.

EVALUATING THE EFFICIENCY OF PHYSIOLOGICAL ICSI (PICSI) IN PATIENTS WITH DIFFERENT LEVELS OF ABNORMAL SPERM DNA FRAGMENTATION

To evaluate the efficiency of sperm selection by PICSI on males with different levels of abnormal sperm DNA fragmentation (SDF). A retrospective cohort study included 630 couples undergoing ICSI from October 2016 to October 2019. Cases were divided according to their SDF levels into: (Mild: 20.4-25%, Moderate: 25.1-30%, and Severe: >30%) and normal SDF (<20% control) groups. The study included females ≤37 years old, with a minimum of 5 mature oocytes injected and had a fresh blastocyst transfer. All males SDF levels were assessed prior to their ICSI cycles using the terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) assay. Comparisons included pre-implantation embryo development, pregnancy, and live birth rates. The Chi square test was used for the qualitative parameters and Kruskal Walis test for non-parametric quantitative parameters (SPSS version 23). We found no significant differences between the control and high SDF groups in: type of infertility, female age, male age, count, motility, abnormal morphology, smoking status, abstinence days, No. of retrieved oocytes, and No. of mature oocytes. The outcomes of ICSI versus PICSI for the different study groups are shown in Table 1.Tabled 1Study outcomesNormal SDF n=291PICSIp-valuesMild n=147Moderate n=93Severe n=99Cleavage rate (%)75.6±18.275.3±16.677±17.978.8±14.80.6Blastocyst rate (%)64.7±19.663.2±2067.1±17.764.8±18.10.82Good quality Blastocyst rate (%)37.2±23.838±27.233±22.833.8±25.10.27Fair quality Blastocyst rate (%)17±17.115.2±18.215.2±15.618.4±17.30.5Vitrified Blastocysts3.36±3.53.37±3.52.64±2.22.67±2.70.65Implantation rate (%)44.5±43.241.5±40.738.4±44.434.4±39.20.09Clinical pregnancy rate (%)*64.461.355.760.20.53Ongoing pregnancy rate (%)*54.645.245.252.30.22Miscarriage rate (%)*14.523.515.68.20.11Live birth rate (%)*53.64343.951.20.16Data are mean (SD), otherwise stated. n refers to the number of cycles. PICSI = physiological intracytoplasmic sperm injection. SDF = Sperm DNA fragmentation. * Data are percentages only. P values <0.05 are considered significant. Open table in a new tab PICSI can perform with the same efficiency at all levels of abnormal SDF, improving their reproductive outcomes to the level of the control group. A prospective randomized trial with a control of abnormal SDF is planned as a future study to confirm these findings.

P–084 Microfluidic Sperm Sorting (MFSS) technique versus Physiological Intracytoplasmic Sperm Injection (PICSI) technique in high DNA fragmentation index sperm samples

Abstract Study question To evaluate the effectiveness of using Microfluidic Sperm Sorting (MFSS) technique and Physiological Intracytoplasmic Sperm Injection (PICSI) technique in patient with high DNA fragmentation index (DFI) sperm samples. Summary answer Sperm selected by microfluidic sorting are associated with significant increase in day 3 grade A embryo development rate, clinical pregnancy rate over PICSI. What is known already DNA damage is unrecognisable in living sperm prior to insemination and an increased sperm DNA fragmentation index has been associated with lower fertilization rates, impaired embryo development and reduced pregnancy rates. Standard semen processing techniques are associated with centrifugation, which may induce reactive oxygen species and DNA damage. In strategies to minimize sperm DNA fragmentation, Physiological ICSI can relatively reduce sperm DNA fragmentation by 67.9% (Parmegiani et al., 2010) while new technique Microfluidic sperm sorter technique also demonstrate sperm selection with significantly reduced DNA damage. Study design, size, duration A prospective randomised study was conducted from 1st August 2019 to 31st December 2020. Two hundred patients were randomised by computer generated list and divided into 2 groups. Group A (n = 100) , in which sperm were processed by microfluidic sperm sorter (MFSS) while in group B (n = 100), sperm were selected by Physiological Intracytoplasmic Sperm Injection (PICSI) technique and morphologically normal motile sperm were injected by Intracytoplasmic sperm injection (ICSI) technique in all mature oocytes. Participants/materials, setting, methods The study period included all normozoospermic patients with high DNA fragmentation index (&amp;gt;25% ) while oligospermic, asthenozoospermic samples, patients with poor ovarian reserve and advanced age were excluded from the study. All A grade embryos were vitrified and transferred in frozen embryo replacement cycle. Both groups were compared on the basis of fertilisation rate, day 3 grade A embryo development rate , clinical pregnancy rate and miscarriage rate. Main results and the role of chance Cycle characteristics (female age, length of stimulation, gonadotrophin dose, number of oocytes and number of transferred embryos) were similar in both groups. Between the 2 groups, There was a significant increase observed in day 3 grade A embryo development rate (60% vs. 42%, p–0.016) and clinical pregnancy rate (62% vs. 46%, p–0.049), while no statistical significant difference observed in fertilisation rate (82% vs. 78%, p–0.80) and miscarriage rate ( 12% vs. 11%, p- 1). Limitations, reasons for caution: Larger randomised control studies are needed to strengthen these results. Wider implications of the findings: We have demonstrated that sperm sorted by microfluidic helps in selection of sperm with better DNA integrity over Physiological ICSI. Using it in routine practice can help in reducing the negative effect of reactive oxygen species and thus improve pregnancy rate and live birth rate. Trial registration number MCDH/2019/31

Sperm Selection Technology in ART.

Intracytoplasmic sperm injection (ICSI) is a commonly used in vitro fertilization technique. Selection of sperm for injection is currently done using subjective assessment of morphology, which may not accurately identify the best-quality sperm. Hyaluronic acid receptors on sperm plasma membranes are a marker of maturity, and sperms which are capable of binding immobilized hyaluronic acid in vitro are of higher quality. This can be used as an advanced sperm selection technique to choose sperm for ICSI, termed physiological ICSI (PICSI). Several studies reported improved fertility treatment outcomes when using PICSI compared with conventional ICSI; however, the majority of studies are underpowered. Recently, a large, multicenter, randomized controlled trial, known as the Hyaluronic Acid Binding Sperm Selection (HABSelect) trial, found a significant reduction in miscarriage rates with PICSI, but no significant effect on live birth rate. There are still many avenues through which PICSI may provide an advantage, subject to confirmation by future research, such as improved long-term health of offspring. Other advanced sperm selection techniques include intracytoplasmic morphologically selected sperm injection, magnetic-activated cell sorting, and Zeta potential sperm selection; however, the most recent Cochrane review concluded that there is currently insufficient evidence to ascertain whether these techniques improve clinical outcomes, such as live birth rates.

Comparison of physiological-ICSI (PICSI) with ICSI in cases of moderate to severe oligoasthenoteratozoospermia (OAT) − a randomized control study

Objective: To compare the efficiency of physiological intracytoplasmic sperm injection (PICSI) over intracytoplasmic sperm injection (ICSI) in Oligoasthenoteratozoospermic patients. Design: Randomized control study. Setting: KJIVF and laparoscopy center Delhi. Methods: From September 2019 to May 2020, 45 patients of male factor felled under our criteria of OAT were divided into two groups of PICSI and ICSI. Sperm selection was performed under high magnification in both the groups and results were compared. Outcome measure: Primary outcome: Fertilization rate, cleavage rate, blastulation, and utility rate; Secondary outcome: Clinical pregnancy rates and miscarriage rates. Results: 20 PICSI and 25 ICSI treatments were performed and observed that the rate of blastulation and embryo utility shows significant difference in PICSI group (P = 0.013). The pregnancy percentage was also better in PICSI but implantation, fertilization, cleavage; clinical pregnancy rates were clinically comparable in both the groups but not statistically significant. Conclusion: The outcomes of our study are independent of male factor and it only depends on intervention whether it was PICSI or ICSI. The blastulation rate and embryo utility shows statistically significant difference between PICSI and ICSI groups. Hence, we are slowly progressing toward the superiority of PICSI over ICSI but enough evidences are still not available.

Comparison of physiological-ICSI (PICSI) with ICSI in cases of moderate to severe oligoasthenoteratozoospermia (OAT) − a randomized control study

Objective: To compare the efficiency of physiological intracytoplasmic sperm injection (PICSI) over intracytoplasmic sperm injection (ICSI) in Oligoasthenoteratozoospermic patients. Design: Randomized control study. Setting: KJIVF and laparoscopy center Delhi. Methods: From September 2019 to May 2020, 45 patients of male factor felled under our criteria of OAT were divided into two groups of PICSI and ICSI. Sperm selection was performed under high magnification in both the groups and results were compared. Outcome measure: Primary outcome: Fertilization rate, cleavage rate, blastulation, and utility rate; Secondary outcome: Clinical pregnancy rates and miscarriage rates. Results: 20 PICSI and 25 ICSI treatments were performed and observed that the rate of blastulation and embryo utility shows significant difference in PICSI group (P = 0.013). The pregnancy percentage was also better in PICSI but implantation, fertilization, cleavage; clinical pregnancy rates were clinically comparable in both the groups but not statistically significant. Conclusion: The outcomes of our study are independent of male factor and it only depends on intervention whether it was PICSI or ICSI. The blastulation rate and embryo utility shows statistically significant difference between PICSI and ICSI groups. Hence, we are slowly progressing toward the superiority of PICSI over ICSI but enough evidences are still not available.

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

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).

New Approach of Hyaluronic Acid Bound Spermatozoa-ICSI in Iraqi Infertile Patients

Background: Ability of spermatozoa to binding to hyaluronan is related to sperm membrane maturity and fertilizing potential, thus it has been suggested that sperm selection using Hyaluronic acid (HA) could increase the implantation rate in Intracytoplasmic Sperm Injection(ICSI). Basically Physiological -ICSI (PICSI) is a scientific technique used in ICSI, is a specialized form and more filtered way of selecting the best competent sperm for fertilization process. Despite the fact that conventionally spermatozoa are selected for ICSI based on their morphology and motility. Objective: To evaluate whether (PICSI) has the potential to improve the fertilization rate and embryo grading. Patients, Materials and Methods: Fifty-three infertile couples subjected to an in vitro fertilization stimulation program; Thirty-five underwent (ICSI) cycle and eighteen underwent (PICSI) cycle, assessed the fertilization rate and embryo grading at cleavage stage then the results were statistically analyzed. Results: In spite of the fertilization rate of PICSI group was better than ICSI group but statistically no significant difference was noticed between both of them. In regarding to embryo grading at cleavage stage, there was a significant increase(P&lt;0.05) in Grade 1 and Grade 2 for PICSI group as compared to ICSI group. Conclusions: The percentage of fertilization for PICSI group is better than for ICSI group. In regarding to statistical analysis, there was no significant differences between two groups. Regarding to embryo quality at cleavage stage, the PICSI cycle significantly improves embryo quality(Grade 1 and Grade 2) at day 2 and day 3 of development as compared to the ICSI cycle.

Sperm selection for assisted reproduction by prior hyaluronan binding: the HABSelect RCT

BackgroundSperm selection for intracytoplasmic sperm injection (ICSI) has traditionally relied on standardised methods of sperm processing combined with subjective sperm selection (motility/morphology). In 2012, live birth rates (LBRs) stood at ≈24% per cycle started (32% per cycle reaching embryo transfer).Objective(s)The main clinical objective was to determine the benefits of a hyaluronan (HA)-based sperm selection process for physiological intracytoplasmic sperm injection (PICSI). A parallel, mechanistic objective evaluated sperm chromatin integrity and the potential of PICSI to compensate for poor sperm quality.DesignA Phase III, parallel-arm, blinded randomised controlled trial (RCT) of efficacy of PICSI versus ICSI alongside mechanistic evaluation.SettingThe RCT ran from February 2014 to August 2016, involving NHS (n = 14) and private (n = 2) UK hospital or satellite clinics. Mechanistic work was conducted in three university-based research laboratories and a partnering small–medium enterprise from June 2015 to December 2017.ParticipantsCouples undergoing an ICSI procedure using freshly ejaculated sperm with female partners aged between 18 and 43 years and male partners aged between 18 and 55 years.InterventionHealth and Care Professions Council-registered embryologists used the Medicines and Healthcare products Regulatory Agency-registered (HA-coated) PICSI™ dish (Origio, Måløv, Denmark) to select a single sperm for injection. Control couples received standard care.Main outcome measuresClinical – the primary outcome was full-term live birth (≥ 37 weeks’ gestation). Secondary outcome measures were confirmed clinical pregnancy (CP), miscarriage following confirmation and preterm live birth (&lt; 37 weeks’ gestation). Mechanistic – measurement models were designed for deoxyribonucleic acid (DNA) fragmentation, compaction and HA binding [HA binding score (HBS)].ResultsA total of 2772 couples were randomised and 2752 couples were included in the primary analysis (PICSI,n = 1371; and ICSI,n = 1381). Clinical – primary outcome: 379 out of 1381 (27.4% PICSI) and 346 out of 1371 (25.2% ICSI) couples who were randomised (up to 24 hours before treatment) into the trial achieved a term live birth ≥ 37 weeks’ gestation [odds ratio (OR) 1.12, 95% confidence interval (CI) 0.94 to 1.34;p = 0.18]. Subgroup analyses did not reveal differences in treatment effects for HBS, maternal age, previous miscarriage, follicle-stimulating hormone or anti-Müllerian hormone levels and paternal sperm concentrations. Secondary outcomes: CP was achieved for 487 out of 1382 (35.2% PICSI) and 491 out of 1375 (35.7%, ICSI) couples (OR 0.98, 95% CI 0.84 to 1.15;p = 0.80). Miscarriage affected 60 out of 1381 (4.3% PICSI) and 96 out of 1371 (7.0% ICSI) of couples (OR 0.61, 95% CI 0.43 to 0.84;p = 0.003). Preterm LBRs were 46 out of 1381 (3.3% PICSI) and 45 out of 1371 (3.3% ICSI) (OR 1.02, 95% CI 0.67 to 1.55;p = 0.94). Mechanistic: in the subset of samples examined, HBS correlated with sperm motility, concentration, fertilisation rate and DNA fragmentation. Sperm DNA compaction was weakly associated with clinical pregnancy rates (CPRs), but neither HBS nor DNA fragmentation was predictive of any clinical outcome.LimitationsEmbryologists were not blinded and limited data were available from poorer samples and non-random sample selection in the mechanistic cohort. Prepared rather than raw semen was used for tests of DNA integrity.ConclusionsPICSI offered no clear advantage in relation to the primary outcome. PICSI led to a reduced miscarriage risk, but had no effect on CPR or preterm LBR.Future workRe-evaluate PICSI focusing on CP and miscarriage rates and consider aspects of sperm quality that PICSI favours.Trial registrationCurrent Controlled Trials ISRCTN99214271.FundingThis project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. The research is also supported by the NIHR Infrastructure at Leeds and the NIHR Clinical Research Network.

Physiological, hyaluronan-selected intracytoplasmic sperm injection for infertility treatment (HABSelect): a parallel, two-group, randomised trial

SummaryBackgroundSperm selection strategies aimed at improving success rates of intracytoplasmic sperm injection (ICSI) include binding to hyaluronic acid (herein termed hyaluronan). Hyaluronan-selected sperm have reduced levels of DNA damage and aneuploidy. Use of hyaluronan-based sperm selection for ICSI (so-called physiological ICSI [PICSI]) is reported to reduce the proportion of pregnancies that end in miscarriage. However, the effect of PICSI on livebirth rates is uncertain. We aimed to investigate the efficacy of PICSI versus standard ICSI for improving livebirth rates among couples undergoing fertility treatment.MethodsThis parallel, two-group, randomised trial included couples undergoing an ICSI procedure with fresh embryo transfer at 16 assisted conception units in the UK. Eligible women (aged 18–43 years) had a body-mass index of 19–35 kg/m2 and a follicle-stimulating hormone (FSH) concentration of 3·0–20·0 mIU/mL or, if no FSH measurement was available, an anti-müllerian hormone concentration of at least 1·5 pmol/L. Eligible men (aged 18–55 years) had not had a vasovasostomy or been treated for cancer in the 24 months before recruitment and were able, after at least 3 days of sexual abstinence, to produce freshly ejaculated sperm for the treatment cycle. Couples were randomly assigned (1:1) with an online system to receive either PICSI or a standard ICSI procedure. The primary outcome was full-term (≥37 weeks' gestational age) livebirth, which was assessed in all eligible couples who completed follow-up. This trial is registered, number ISRCTN99214271.FindingsBetween Feb 1, 2014, and Aug 31, 2016, 2772 couples were randomly assigned to receive PICSI (n=1387) or ICSI (n=1385), of whom 2752 (1381 in the PICSI group and 1371 in the ICSI group) were included in the primary analysis. The term livebirth rate did not differ significantly between PICSI (27·4% [379/1381]) and ICSI (25·2% [346/1371]) groups (odds ratio 1·12, 95% CI 0·95–1·34; p=0·18). There were 56 serious adverse events in total, including 31 in the PICSI group and 25 in the ICSI group; most were congenital abnormalities and none were attributed to treatment.InterpretationCompared with ICSI, PICSI does not significantly improve term livebirth rates. The wider use of PICSI, therefore, is not recommended at present.FundingNational Institute for Health Research Efficacy and Mechanism Evaluation Programme.

Sperm selection for ICSI using hylauronan binding in males with high DNA fragmentation does not appear to select against sperm chromosome aneuploidies

Hyalyronic acid (HA) surrounding the human oocyte acts as a natural selector for morphologically normal sperm with hyaluronic acid receptors and minimal DNA fragmentation. An association between high sperm DNA fragmentation and pregnancy loss has been reported, however the clinical value of selecting sperm for intracytoplasmic sperm injection (ICSI) in conjunction with hyaluronic acid binding assays remains to be clarified. The objective of this study was to evaluate the IVF outcomes of sperm with low HA-binding ability (≤65%) following physiological ICSI (PICSI). Retrospective study. Infertility patients with high sperm DNA fragmentation (≥14%; TUNEL assay) that underwent in vitro fertilization (IVF) and PICSI with low HA-binding ability (≤65%; n=23) were evaluated for IVF outcomes including fertilization, blastocyst development and chromosome constitution. Euploid frozen embryo transfer (FET) outcomes which included implantation rate with fetal heart tone, miscarriage rates and live birth rates, were compared to maternally age-matched infertility patients with normal sperm DNA fragmentation that underwent IVF with ICSI. Statistical analysis was performed using Students t-test and Chi square test where appropriate, significance at P<0.05. Mean maternal and paternal ages for these PICSI patients with low HA-binding ability were 37.9±3.7 and 40.9±6.2 years, respectively. High sperm DNA fragmentation (mean 21.5±6.3%) was the only male factor variable significantly associated with these couples. Fertilization and usable blastocyst development with PICSI selected sperm was observed at acceptable rates of 78% and 46%, respectively. Following trophectoderm biopsy, 38% of blastocysts were identified as euploid, significantly less than maternally age-matched ICSI patients at 52% (P<0.05). To date, there have been 12 euploid FETs resulting in comparable good clinical outcomes to maternally age-matched ICSI patients: 66.7% implantation with fetal heart tone, 83.3% live birth and no clinical pregnancy losses. There were 7 cycles that resulted in all aneuploid blastocysts with no FET, thereby calculating a 45.5% live birth rate from oocyte retrieval for PICSI patients with high sperm DNA fragmentation and low HA-binding ability. No significant differences were observed for the chromosomes involved in the errors between the aneuploid blastocysts from the PICSI patients with low HA-binding ability and the maternally age-matched ICSI patients. In conclusion, this study revealed that PICSI patients with high sperm DNA fragmentation and low HA-binding ability have significantly higher blastocyst aneuploidy rates than maternally age-matched ICSI patients. Nevertheless, following a euploid FET these patients exhibited positive clinical outcomes and no pregnancy losses to date.