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Cariati F, Orsi MG, Bagnulo F, Del Mondo D, Vigilante L, De Rosa M, Sciorio R, Conforti A, Fleming S, Alviggi C. Advanced Sperm Selection Techniques for Assisted Reproduction. J Pers Med 2024; 14:726. [PMID: 39063980 PMCID: PMC11278480 DOI: 10.3390/jpm14070726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Male infertility accounts for approximately 40% of infertility cases. There are many causes of male infertility, including environmental factors, age, lifestyle, infections, varicocele, and cancerous pathologies. Severe oligozoospermia, cryptozoospermia, and azoospermia (obstructive and non-obstructive) are identified as severe male factor infertility, once considered conditions of sterility. Today, in vitro fertilization (IVF) techniques are the only treatment strategy in cases of male factor infertility for which new methodologies have been developed in the manipulation of spermatozoa to achieve fertilization and increase success rates. This review is an update of in vitro manipulation techniques, in particular sperm selection, emphasizing clinical case-specific methodology. The success of an IVF process is related to infertility diagnosis, appropriate choice of treatment, and effective sperm preparation and selection. In fact, selecting the best spermatozoa to guarantee an optimal paternal heritage means increasing the blastulation, implantation, ongoing pregnancy and live birth rates, resulting in the greater success of IVF techniques.
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Affiliation(s)
- Federica Cariati
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Maria Grazia Orsi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (M.G.O.); (A.C.)
| | - Francesca Bagnulo
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Daniela Del Mondo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy;
| | - Luigi Vigilante
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Martina De Rosa
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Romualdo Sciorio
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman Mother Child, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (M.G.O.); (A.C.)
| | - Steven Fleming
- Discipline of Anatomy & Histology, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, Australia;
| | - Carlo Alviggi
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
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Balder P, Jones C, Coward K, Yeste M. Sperm chromatin: Evaluation, epigenetic signatures and relevance for embryo development and assisted reproductive technology outcomes. Eur J Cell Biol 2024; 103:151429. [PMID: 38905808 DOI: 10.1016/j.ejcb.2024.151429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
Sperm chromatin is distinct from somatic cell chromatin, as a result of extensive remodeling during the final stages of spermatogenesis. In this process, the majority of histones is replaced with protamines. The chromatin is consequently highly condensed and inert, which facilitates protection of the DNA. The sperm epigenomic landscape is shaped by histone retention, histone and protamine modification, DNA methylation, and RNAs. In recent years, sperm chromatin integrity and its epigenetic marks have been increasingly studied, and the constitution of sperm chromatin is steadily being uncovered. This growing body of research prompts assessment of the frequently overlooked involvement of sperm in fertility and embryonic development. Moreover, numerous endogenous and exogenous factors are known to affect sperm chromatin, which may in turn impact the reproductive success. Concerns have been raised about the effects of assisted reproductive technology (ART) on the sperm epigenome, embryonic development and offspring health. This review examines the structure and epigenetic signatures of sperm chromatin in the context of fertility and early embryonic development. Additionally, sperm chromatin evaluation and causes of aberrant integrity are outlined. Building on the knowledge discussed in the current review, future research should aim to elucidate the intricate relationship between all aspects of sperm chromatin and embryo development. This could lead to the uncovering of new targets for treating infertility, as well as the acquisition of much needed insights into the possible reciprocal association between ART and sperm chromatin integrity.
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Affiliation(s)
- Pauline Balder
- Nuffield Department of Women's and Reproductive Health, Level 3, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Celine Jones
- Nuffield Department of Women's and Reproductive Health, Level 3, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Kevin Coward
- Nuffield Department of Women's and Reproductive Health, Level 3, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Marc Yeste
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona ES-17003, Spain; Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona ES-17003, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona ES-08010, Spain.
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Tilak P, Bawaskar PA, Badge A, Kohale M, Makade JG, Nair N. Resolving Secondary Infertility: A Case Report of the Successful Treatment of Sperm DNA Fragmentation Through the Physiological Intracytoplasmic Sperm Injection Method. Cureus 2024; 16:e53682. [PMID: 38455827 PMCID: PMC10918439 DOI: 10.7759/cureus.53682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
This case report presents an illustrative account of a couple experiencing secondary infertility attributed to the fragmentation of DNA in sperm. Secondary infertility, the inability to conceive after having previously successfully conceived a child, can be due to various factors, including male infertility issues. Sperm DNA fragmentation (SDF) has emerged as a major factor influencing male fertility, resulting in poor embryo development and lower pregnancy rates. This case is about the use of advanced assisted reproductive technologies, specifically physiological intracytoplasmic sperm injection (PICSI) and intracytoplasmic sperm injection (ICSI), to treat secondary infertility caused by fragmentation of sperm DNA. PICSI enables the identification and selection of spermatozoa with optimal functional integrity using hyaluronan, a natural binding substance. Preparing a PICSI dish requires skill and precision. Sperm exhibiting a high DNA fragmentation index were excluded from the selection process to enhance embryo development potential. The couple underwent controlled ovarian stimulation, egg retrieval, and ICSI with PICSI. The treatment resulted in the successful conception of a singleton pregnancy. Subsequent prenatal monitoring indicated a healthy pregnancy progression, ultimately culminating in the delivery of a healthy baby girl at term. This case report highlights the efficacy of integrating PICSI as a sperm selection method preceding ICSI, specifically in cases of secondary infertility related to SDF. Further research and larger-scale studies are warranted to approve the findings of this case report and establish the broader applicability of this treatment approach.
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Affiliation(s)
- Priyal Tilak
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Pranita A Bawaskar
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Mangesh Kohale
- Pathology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Jagadish G Makade
- Community Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Nancy Nair
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
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Kadu KS, More A, Choudhary N, Dutta S, Shrivastava J, Gajabe G. Application of Physiological Sperm Selection in Assisted Reproductive Technology (ART) for Patients With Diabetes Mellitus: A Case Report. Cureus 2024; 16:e53018. [PMID: 38410342 PMCID: PMC10895562 DOI: 10.7759/cureus.53018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
This case report revolves around a 35-year-old woman and her 39-year-old husband, who have been married for 10 years and were seeking treatment for their secondary infertility. The husband had been diagnosed with diabetes mellitus (DM) for the past seven years and had been on continued medication. Both partners underwent medical evaluations, and the husband was found to have normozoospermia. The wife had a normal ovarian reserve but was still facing difficulties in conception. Previous medical history showed that the husband's DM had been treated with metformin, and the woman had a history of unsuccessful in vitro fertilization (IVF) cycles and one miscarriage upon investigation. Our initial treatment attempt had failed, and upon assessment of the semen, it revealed a significantly increased sperm DNA fragmentation index, leading us to consider physiological intracytoplasmic sperm injection (PICSI). The couple then opted for a rescheduled ovum pick-up with PICSI over traditional ICS. PICSI involves selecting mature sperm with hyaluronic acid affinity, aiming to avoid immature, morphologically defective spermatozoa during microinjection. The couple then followed up for treatments; the husband continued with diabetes treatment, and the woman was advised to take progesterone supplements to ensure optimum uterine thickness. The PICSI procedure was followed by a successful embryo transfer, which subsequently led to a positive clinical pregnancy. This report highlights the importance of utilizing advanced technologies like PICSI in infertility cases after considering factors such as sperm quality to enhance the chances of a successful clinical pregnancy.
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Affiliation(s)
- Krushnali S Kadu
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Akash More
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Namrata Choudhary
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shilpa Dutta
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jarul Shrivastava
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gauri Gajabe
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Inversetti A, Bossi A, Cristodoro M, Larcher A, Busnelli A, Grande G, Salonia A, Di Simone N. Recurrent pregnancy loss: a male crucial factor-A systematic review and meta-analysis. Andrology 2023. [PMID: 37881014 DOI: 10.1111/andr.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/12/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Recurrent pregnancy loss (RPL), defined as two or more failed clinical pregnancies, affects 1%-3% of couples trying to conceive. Nowadays up to 50% of cases remain idiopathic. In this context, paternal factors evaluation is still very limited. The aim is to address the topic of the male factor in RPL with a broad approach, analyzing collectively data on sperm DNA fragmentation (SDF) and semen parameters. We systematically searched in Pubmed/MEDLINE and Google Scholar from inception to February 2023. A protocol has been registered on PROSPERO (ID number CRD42022278616). PRISMA guidelines were followed. METHODS Pooled results from 20 studies revealed a higher DNA fragmentation rate in the RPL group compared to controls (mean difference [MD] 9.21, 95% CI 5.58-12.85, p < 0.00001, I2 98%). Age, body mass index (BMI), smoking, and alcohol intake were not associated with DNA fragmentation. Subgroup analysis by different SDF assays (TUNEL and COMET at a neutral pH vs. indirect assessment with other assays) and ethnicity did not highlight different results (p = 0.25 and 0.44). RESULTS Results pooled from 25 studies showed a significant difference comparing RPL and control groups regarding ejaculation volume (MD -0.24, 95% CI -0.43; -0.06, p 0.01, I2 66%), total sperm number (MD -10.03, 95% CI -14.65; -5.41, p < 0.0001, I2 76%), total sperm motility (MD -11.20, 95% CI -16.15; -6.25, p < 0.0001, I2 96%), progressive sperm motility (MD -7.34, 95% CI -10.87; -3.80, p < 0.0001, I2 97%), and normal sperm morphology (MD -5.99, 95% CI -9.08; -2.90, p 0.0001, I2 98%). A sub-analysis revealed that Asian and Africans, but not white-European RPL men had lower progressive sperm motility compared to controls. CONCLUSION In conclusion, current review and meta-analysis findings suggested that SDF and some specific semen parameters were associated with RPL in a multi-ethnic evaluation. This effort opens future direction on a growing awareness of, first, how the male factor plays a key role and, second, how appropriate would be to establish a direct dialogue between the gynecologist and the urologist. PATIENT SUMMARY We performed a systematic review and meta-analysis on the male component of RPL. We found that sperm DNA fragmentation and some specific sperm parameters are significantly associated with RPL.
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Affiliation(s)
- Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Arianna Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giuseppe Grande
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
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Le MT, Nguyen HTT, Van Nguyen T, Nguyen TTT, Dang HNT, Dang TC, Nguyen QHV. Physiological intracytoplasmic sperm injection does not improve the quality of embryos: A cross-sectional investigation on sibling oocytes. Clin Exp Reprod Med 2023; 50:123-131. [PMID: 37258106 DOI: 10.5653/cerm.2023.05918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/27/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Minh Tam Le
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Hiep Tuyet Thi Nguyen
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Trung Van Nguyen
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thai Thanh Thi Nguyen
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Hong Nhan Thi Dang
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thuan Cong Dang
- Department of Histology and Embryology, Pathology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Quoc Huy Vu Nguyen
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Emirdar V, Karatasli V, Tamer B, Pala I, Gunturkun F, Ozbaykus C, Işık AZ, Gode F. Influence of a hyaluronan-binding system for sperm selection in intracytoplasmic sperm injection cycles on embryo morphokinetic parameters and in vitro fertilization cycle outcomes. Arch Gynecol Obstet 2023; 307:1633-1639. [PMID: 36892604 DOI: 10.1007/s00404-023-06992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Volkan Emirdar
- Department of Obstetrics and Gynecology, Izmir Economy University School of Medicine, Medical Park Hospital, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey. .,Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey.
| | - Volkan Karatasli
- Department of Obstetrics and Gynecology, SBU. University of Health Science Tepecik Education and Research Hospital, Yenisehir, Gaziler St. No:468, Konak, 35020, Izmir, Turkey
| | - Burcu Tamer
- Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
| | - Ibrahim Pala
- Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
| | - Fatma Gunturkun
- Center for Biomedical Informatics, The University of Tennessee Health Science Center, 875 Monroe Avenue, Memphis, TN, USA
| | - Canberk Ozbaykus
- Intensive Care Unit, Taksim Education and Research Hospital, Katip Mustafa Celebi, Sıraselviler Street No:48, Beyoglu, 34433, Istanbul, Turkey
| | - Ahmet Zeki Işık
- Department of Obstetrics and Gynecology, Izmir Economy University School of Medicine, Medical Park Hospital, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey.,Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
| | - Funda Gode
- Department of Obstetrics and Gynecology, Izmir Economy University School of Medicine, Medical Park Hospital, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey.,Izmir Economy University Medical Park Hospital In Vitro Fertilization Unit, Yeni Girne Blv. 1825 Street No: 12 Karşıyaka, Izmir, Turkey
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Ribas-Maynou J, Barranco I, Sorolla-Segura M, Llavanera M, Delgado-Bermúdez A, Yeste M. Advanced Sperm Selection Strategies as a Treatment for Infertile Couples: A Systematic Review. Int J Mol Sci 2022; 23:ijms232213859. [PMID: 36430331 PMCID: PMC9695162 DOI: 10.3390/ijms232213859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Assisted reproductive technology (ART) is an essential tool to overcome infertility, and is a worldwide disease that affects millions of couples at reproductive age. Sperm selection is a crucial step in ART treatment, as it ensures the use of the highest quality sperm for fertilization, thus increasing the chances of a positive outcome. In recent years, advanced sperm selection strategies for ART have been developed with the aim of mimicking the physiological sperm selection that occurs in the female genital tract. This systematic review sought to evaluate whether advanced sperm selection techniques could improve ART outcomes and sperm quality/functionality parameters compared to traditional sperm selection methods (swim-up or density gradients) in infertile couples. According to preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines), the inclusion and exclusion criteria were defined in a PICOS (population, intervention, comparator, outcome, study) table. A systematic search of the available literature published in MEDLINE-PubMed until December 2021 was subsequently conducted. Although 4237 articles were recorded after an initial search, only 47 studies were finally included. Most reports (30/47; 63.8%) revealed an improvement in ART outcomes after conducting advanced vs. traditional sperm selection methods. Among those that also assessed sperm quality/functionality parameters (12/47), there was a consensus (10/12; 83.3%) about the beneficial effect of advanced sperm selection methods on these variables. In conclusion, the application of advanced sperm selection methods improves ART outcomes. In spite of this, as no differences in the reproductive efficiency between advanced methods has been reported, none can be pointed out as a gold standard to be conducted routinely. Further research addressing whether the efficiency of each method relies on the etiology of infertility is warranted.
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Affiliation(s)
- Jordi Ribas-Maynou
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Isabel Barranco
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40126 Bologna, Italy
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Maria Sorolla-Segura
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Llavanera
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Ariadna Delgado-Bermúdez
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Yeste
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
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9
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West R, Coomarasamy A, Frew L, Hutton R, Kirkman-Brown J, Lawlor M, Lewis S, Partanen R, Payne-Dwyer A, Román-Montañana C, Torabi F, Tsagdi S, Miller D. Sperm selection with hyaluronic acid improved live birth outcomes among older couples and was connected to sperm DNA quality, potentially affecting all treatment outcomes. Hum Reprod 2022; 37:1106-1125. [PMID: 35459947 PMCID: PMC9156852 DOI: 10.1093/humrep/deac058] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY QUESTION What effects did treatment using hyaluronic acid (HA) binding/selection prior to ICSI have on clinical outcomes in the Hyaluronic Acid Binding sperm Selection (HABSelect) clinical trial? SUMMARY ANSWER Older women randomized to the trial's experimental arm (selection of sperm bound to immobilized (solid-state) HA) had the same live birth rates as younger women, most likely a result of better avoidance of sperm with damaged DNA. WHAT IS KNOWN ALREADY Recent randomized controlled trials (RCTs) investigating the efficacy of HA-based sperm selection prior to ICSI, including HABSelect, have consistently reported reductions in the numbers of miscarriages among couples randomized to the intervention, suggesting a pathological sperm-mediated factor mitigated by prior HA-binding/selection. The mechanism of that protection is unknown. STUDY DESIGN, SIZE, DURATION The original HABSelect Phase 3 RCT ran from 2014 to 2017 and included 2752 couples from whom sperm samples used in control (ICSI) and intervention (Physiological IntraCytoplasmic Sperm Injection; PICSI) arms of the trial were stored frozen for later assessment of DNA quality (DNAq). The trial overlapped with its mechanistic arm, running from 2016 to 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS As miscarriage reduction was a significant secondary outcome of the trial, samples (n = 1247) selected for the mechanistic analysis were deliberately enriched for miscarriage outcomes (n = 92 or 7.4%) from a total of 154 miscarriages (5.6%) among all (n = 2752) couples randomized by stratified random sampling. Values from fresh semen samples for sperm concentration (mml), percentage forward progressive motility and percentage HA-binding score (HBS) were obtained before being processed by differential density gradient centrifugation or (rarely) by swim-up on the day of treatment. Surplus sperm pellets were recovered, aliquoted and cryopreserved for later analysis of DNAq using slide-based Comet, TUNEL, acridine orange (AO) and the sperm chromatin dispersion (SCD) assays. Following their classification into normal and abnormal sample subcategories based on reference values for sperm concentration and motility, relationships with HBS and DNAq were examined by Spearman correlation, Student's t-tests, Mann Whitney U tests, and logistic regression (univariable and multivariable). Parsimonious selection enabled the development of models for exploring and explaining data trends. Potential differences in future cumulative pregnancy rates relating to embryo quality were also explored. MAIN RESULTS AND THE ROLE OF CHANCE Results from the 1247 sperm samples assayed for HBS and/or DNAq, generated data that were considered in relation to standard physiological measures of (sperm) vitality and to treatment outcomes. All measures of HBS and DNAq discriminated normal from abnormal sperm samples (P < 0.001). SCD correlated negatively with the Comet (r = -0.165; P < 0.001) and TUNEL assays (r = -0.200; P < 0.001). HBS correlated negatively with AO (r = -0.211; P < 0.001), Comet (r = -0.127; P < 0.001) and TUNEL (r = -0.214; P < 0.001) and positively with SCD (r = 0.255; P < 0.001). A model for predicting live birth (and miscarriage) rates included treatment allocation (odds ratio: OR 2.167, 95% CI 1.084-4.464, P = 0.031), female age (OR 0.301, 95% CI 0.133-0.761, P = 0.013, per decade) and the AO assay (OR 0.79, 95% CI 0.60-1. 02.761, P = 0.073, per 10 points rise). A model predicting the expected rate of biochemical pregnancy included male age (OR 0.464, 95% CI 0.314-0.674, P < 0.001, per decade) and the SCD assay (OR 1.04, 95% CI 1.007-1.075, P = 0.018, per 10 point rise). A model for conversion from biochemical to clinical pregnancy did not retain any significant patient or assay variables. A model for post-injection fertilization rates included treatment allocation (OR 0.83, 95% CI 0.75-0.91, P < 0.001) and the Comet assay (OR 0.950, 95% CI 0.91-1.00, P = 0.041). LIMITATIONS, REASONS FOR CAUTION HABSelect was a prospective RCT and the mechanistic study group was drawn from its recruitment cohort for retrospective analysis, without the full benefit of randomization. The clinical and mechanistic aspects of the study were mutually exclusive in that measures of DNAq were obtained from residual samples and not from HA-selected versus unselected sperm. Models for fitting mechanistic with baseline and other clinical data were developed to compensate for variable DNAq data quality. HABSelect used a solid-state version of PICSI and we did not assess the efficacy of any liquid-state alternatives. PICSI reduced fertilization rates and did not improve the outlook for cumulative pregnancy rates. WIDER IMPLICATIONS OF THE FINDINGS Notwithstanding the interventional effect on fertilization rates and possibly blastocyst formation (neither of which influenced pregnancy rates), poor sperm DNAq, reflected by lower HBS, probably contributed to the depression of all gestational outcomes including live births, in the HABSelect trial. The interventional avoidance of defective sperm is the best explanation for the equalization in live birth rates among older couples randomized to the trial's PICSI arm. As patients going forward for assisted conception cycles globally in future are likely to be dominated by an older demographic, HA-based selection of sperm for ICSI could be considered as part of their treatment plan. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the National Institute for Health Research (NIHR) EME (Efficacy and Mechanism Evaluation)-11-14-34. National Research Ethics Service approval 11/06/2013: 13/YH/0162. S.L. is CEO of ExamenLab Ltd (company number NI605309). TRIAL REGISTRATION NUMBER ISRCTN99214271.
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Affiliation(s)
- Robert West
- Correspondence address. Leeds Institute of Health Sciences, Room 1.27, Level 10, Worsley Building, University of Leeds, Leeds LS2 9JT, UK. E-mail: (R.W.); Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK. E-mail: (J.K.-B.)
| | - Arri Coomarasamy
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Lorraine Frew
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Rachel Hutton
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Jackson Kirkman-Brown
- Correspondence address. Leeds Institute of Health Sciences, Room 1.27, Level 10, Worsley Building, University of Leeds, Leeds LS2 9JT, UK. E-mail: (R.W.); Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham B15 2TG, UK. E-mail: (J.K.-B.)
| | - Martin Lawlor
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Sheena Lewis
- Queen’s University Belfast, Centre for Public Health, Royal Groups of Hospitals, Belfast, UK
| | - Riitta Partanen
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Alex Payne-Dwyer
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Claudia Román-Montañana
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - Forough Torabi
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - Sofia Tsagdi
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women’s Fertility Centre, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
| | - David Miller
- Department of Discovery and Translational Science, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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10
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Yu SX, Liu Y, Wu Y, Luo H, Huang R, Wang YJ, Wang X, Gao H, Shi H, Jing G, Liu YJ. Cervix chip mimicking cervical microenvironment for quantifying sperm locomotion. Biosens Bioelectron 2022; 204:114040. [PMID: 35151944 DOI: 10.1016/j.bios.2022.114040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/14/2022]
Abstract
As the gate for sperm swimming into the female reproductive tract, cervix is full of cervical mucus, which plays an important role in sperm locomotion. The fact that sperm cannot pass through the cervical mucus-cervix microenvironment will cause the male infertility. However, how the sperm swim across the cervix microenvironment remains elusive. We used hyaluronic acid (HA), a substitute of cervical mucus to mimic cervix microenvironment and designed a cervix chip to study sperm selection and behavior. An accumulation of sperm in HA confirmed that HA served as a reservoir for sperm, similar to cervical mucus. We found that sperm escaping from HA exhibited higher motility than the sperm accessing into HA, suggesting that HA functions as a filter to select sperm with high activity. Our findings construct a practical platform to explore the sophisticated interaction of sperm with cervix microenvironment, with elaborate swimming indicators thus provide a promising cervix chip for sperm selection with kinematic features on-demand. What's more, the cervix chip allows the convenient use in clinical infertility diagnosis, owing to the advantage of simple, fast and high efficiency.
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Affiliation(s)
- Sai-Xi Yu
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yanan Liu
- School of Physics, State Key Laboratory of Photon Technology in Western China Energy, Northwest University, Xi'an, 710069, China
| | - Yi Wu
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hao Luo
- School of Physics, State Key Laboratory of Photon Technology in Western China Energy, Northwest University, Xi'an, 710069, China
| | - Rufei Huang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Hospital of SIPPR, Fudan University, Shanghai, 200032, China
| | - Ya-Jun Wang
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xuemei Wang
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, 200032, China
| | - Hai Gao
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Huijuan Shi
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, 200032, China.
| | - Guangyin Jing
- School of Physics, State Key Laboratory of Photon Technology in Western China Energy, Northwest University, Xi'an, 710069, China.
| | - Yan-Jun Liu
- Shanghai Institute of Cardiovascular Diseases, Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism (Ministry of Science and Technology), Institutes of Biomedical Sciences, Department of Systems Biology for Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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11
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Rimmer MP, Howie RA, Subramanian V, Anderson RA, Bertolla RP, Beebeejaun Y, Bortoletto P, Sunkara SK, Mitchell RT, Pacey A, van Wely M, Farquhar CM, Duffy JMN, Niederberger C. Outcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic review. Hum Reprod Open 2022; 2022:hoac010. [PMID: 35386119 PMCID: PMC8982407 DOI: 10.1093/hropen/hoac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the primary outcomes and outcome measures used in randomized controlled trials (RCTs) evaluating potential treatments for male infertility in the last 10 years? SUMMARY ANSWER Outcome reporting across male infertility trials is heterogeneous with numerous definitions and measures used to define similar outcomes. WHAT IS KNOWN ALREADY No core outcome set for male infertility trials has been developed. Male infertility trials are unique in that they have potentially three participants, a man, a female partner and their offspring and this will likely lead to significant variation in outcome reporting in randomized trials. STUDY DESIGN SIZE DURATION A systematic review of RCTs mapping outcomes and outcome measures evaluating potential treatments for men with infertility registered in the Cochrane Register of Controlled Trials (CENTRAL) between January 2010 and July 2021. PARTICIPANTS/MATERIALS SETTING METHODS Abstract screening and study selection was undertaken in duplicate using a review protocol that was developed prior to commencing the review. No risk of bias assessment was undertaken as this review aims to report on outcome reporting only. MAIN RESULTS AND THE ROLE OF CHANCE One hundred and seventy-five RCTs were identified, and given the large number of studies we limited our review to the 100 largest trials. Seventy-nine different treatments were reported across the 100 largest RCTs including vitamin and dietary supplements (18 trials), surgical treatments (18 trials) and sperm selection techniques (22 trials). When considering the largest 100 trials (range: 80-2772 participants), 36 primary and 89 secondary outcomes were reported. Forty-seven trials reported a primary outcome and 36 trials clearly defined their primary outcome. Pregnancy outcomes were inconsistently reported and included pregnancy rate (51 trials), pregnancy loss including miscarriage, ectopic pregnancy, stillbirth (9 trials) and live birth (13 trials). Trials consistently reporting the same outcome frequently used different definitions. For example, semen quality was reported by 75 trials and was defined in 7 different ways, including; the World Health Organization (WHO) 2010 criteria (32 trials), WHO 1999 criteria (18 trials), WHO 1992 criteria (3 trials), WHO 1999 and 1992 criteria (1 trial) and the Kruger strict morphology criteria (1 trial). LIMITATIONS REASONS FOR CAUTION We only evaluated the 100 largest trials published in the last 10 years and did not report outcomes on the remaining 75. An outcome was included as a primary outcome only if clearly stated in the manuscript and we did not contact authors to clarify this. As our review mapped outcomes and outcome measures, we did not undertake an integrity assessment of the trials included in our review. WIDER IMPLICATIONS OF THE FINDINGS Most randomized trials evaluating treatments for male infertility report different outcomes. Only half of the RCTs reported pregnancy rate and even fewer reported live birth; furthermore, the definitions of these outcomes varies across trials. Developing, disseminating and implementing a minimum data set, known as a core outcome set, for male infertility research could help to improve outcome selection, collection and reporting. STUDY FUNDING/COMPETING INTERESTS A.P.-chairman of external scientific advisory committee of Cryos International Denmark ApS, member of the scientific advisory board for Cytoswim LDT and ExSeed Health. Guest lecture at the 'Insights for Fertility Conference', funded by MERK SERONO Limited. M.v.W.-holds a ZON-MW research grant. No external funding was obtained for this study.
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Affiliation(s)
| | | | - Venkatesh Subramanian
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK,Edinburgh Fertility Centre, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ricardo Pimenta Bertolla
- Division of Urology, Department of Surgery, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Yusuf Beebeejaun
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sesh K Sunkara
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Madelon van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cindy M Farquhar
- Cochrane Gynaecology and Fertility Group, Auckland, New Zealand,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - James M N Duffy
- Correspondence address. King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK. Tel: +44-7949-066806; E-mail:
| | - Craig Niederberger
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA,Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, IL, USA
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12
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Scaruffi P, Bovis F, Casciano I, Maccarini E, Gazzo I, De Leo C, Massarotti C, Sozzi F, Stigliani S, Anserini P. Hyaluronic acid‐sperm selection significantly improves the clinical outcome of couples with previous ICSI cycles failure. Andrology 2022; 10:677-685. [DOI: 10.1111/andr.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Paola Scaruffi
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL) University of Genova Genova Italy
| | - Ida Casciano
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Elena Maccarini
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Irene Gazzo
- Academic Unit of Obstetrics and Gynecology University of Genova Genova Italy
| | - Caterina De Leo
- Department of Neuroscience Rehabilitation, Ophthalmology Genetics and Maternal‐Child Health (DiNOGMI) University of Genova Genova Italy
| | - Claudia Massarotti
- Department of Neuroscience Rehabilitation, Ophthalmology Genetics and Maternal‐Child Health (DiNOGMI) University of Genova Genova Italy
| | - Fausta Sozzi
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Sara Stigliani
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Paola Anserini
- UOS Physiopathology of Human Reproduction IRCCS Ospedale Policlinico San Martino Genova Italy
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13
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Abstract
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.
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Affiliation(s)
- Catherine Martin
- Salisbury Fertility Centre, Salisbury District Hospital, Salisbury, United Kingdom
| | - Emma Woodland
- Salisbury Fertility Centre, Salisbury District Hospital, Salisbury, United Kingdom
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14
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Bosch E, Espinós JJ, Fabregues F, Fontes J, García-Velasco J, Llácer J, Requena A, Checa MA, Bellver J. ALWAYS ICSI? A SWOT analysis. J Assist Reprod Genet 2020; 37:2081-2092. [PMID: 32578032 PMCID: PMC7492350 DOI: 10.1007/s10815-020-01836-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. METHODS A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. RESULTS The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. CONCLUSION Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.
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Affiliation(s)
- E Bosch
- IVI RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain.
| | - J J Espinós
- Fertty, Ausiàs March 25, 08010, Barcelona, Spain
- Universidad Autónoma de Barcelona, Campus de la UAB, Plaza Cívica, s/n, 08193, Bellaterra (Barcelona), Spain
| | - F Fabregues
- Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, C/Villarroel 160, 08036, Barcelona, Spain
| | - J Fontes
- Hospital Universitario Virgen de las Nieves, Avd Fuerzas Armadas s/n, 18014, Granada, Spain
| | | | - J Llácer
- Instituto Bernabeu Alicante, Av. Albufereta, 31, 03540, Alacant (Alicante), Spain
| | - A Requena
- IVI RMA Madrid, Avda. del Talgo 68, 28023, Madrid, Spain
| | - M A Checa
- Hospital del Mar-Parc de Salut Mar, Paseo Maritimo 25-29, 08005, Barcelona, Spain
| | - J Bellver
- IVI RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
- Departamento de Pediatría, Obstetricia y Ginecología. Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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15
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Hasanen E, Elqusi K, ElTanbouly S, Hussin AE, AlKhadr H, Zaki H, Henkel R, Agarwal A. PICSI vs. MACS for abnormal sperm DNA fragmentation ICSI cases: a prospective randomized trial. J Assist Reprod Genet 2020; 37:2605-2613. [PMID: 32772268 DOI: 10.1007/s10815-020-01913-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE 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). METHODS 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. RESULTS 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 30 years 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 35 years of age in the PICSI group did not reach significance level. CONCLUSIONS 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 30 years, while PICSI is preferred in older females. CLINICAL TRIAL REGISTRATION NUMBER NCT03398317 (retrospectively registered).
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Affiliation(s)
- Eman Hasanen
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt.
| | - Khaled Elqusi
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt
| | | | | | - Hanaa AlKhadr
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt
| | - Hosam Zaki
- IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt
| | - Ralf Henkel
- University of the Western Cape, Cape Town, South Africa.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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16
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Kim SJ, Kim H, Kim TH, Jeong J, Lee WS, Lyu SW. Effect of sperm selection using hyaluronan on fertilization and quality of cleavage-stage embryos in intracytoplasmic sperm injection (ICSI) cycles of couples with severe teratozoospermia. Gynecol Endocrinol 2020; 36:456-459. [PMID: 31657242 DOI: 10.1080/09513590.2019.1681960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This study aimed to evaluate the effect of hyaluronan-selected/physiological intracytoplasmic sperm injection (PICSI) on fertilization and quality of cleavage-stage embryos in infertile couples with ≤1% of spermatozoa with normal strict morphology (severe teratozoospermia). Seventy-seven couples underwent PICSI between October 2017 and December 2018 (PICSI group), while 75 couples underwent conventional intracytoplasmic sperm injection (ICSI) between January 2016 and September 2017 (ICSI group). Good quality embryos (GQEs) were evaluated based on morphology. Patient and cycle characteristics were comparable between the PICSI and ICSI groups, except for age and anti-Müllerian hormone (AMH) level (38.4 ± 3.9 years vs. 36.3 ± 4.3 years, p = .002 and 2.06 ± 1.99 ng/mL vs. 2.97 ± 3.25 ng/mL, p = .040). The fertilization rate per oocyte inseminated and GQE rate were significantly higher in the PICSI group than in the ICSI group (82.7% vs. 71.7%, p ˂ .001 and 52.8% vs. 34.0%, p ˂ .001). Furthermore, the absence of GQEs was found to be lower in the PICSI group (13.0% vs. 30.7%, p = .008). Multivariate analysis adjusted for age and AMH level identified PICSI as an unfavorable and independent factor for the absence of GQEs (adjusted odds ratio, 0.333; 95% confidence interval, 0.125-0.890). PICSI seems to be superior to ICSI in terms of fertilization and embryo quality in couples with severe teratozoospermia.
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Affiliation(s)
- Se Jeong Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Hyunjin Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Tae Hyung Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Jihye Jeong
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Sang Woo Lyu
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
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Oseguera-López I, Ruiz-Díaz S, Ramos-Ibeas P, Pérez-Cerezales S. Novel Techniques of Sperm Selection for Improving IVF and ICSI Outcomes. Front Cell Dev Biol 2019; 7:298. [PMID: 31850340 PMCID: PMC6896825 DOI: 10.3389/fcell.2019.00298] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022] Open
Abstract
Almost 50% of the infertility cases are due to male factors. Assisted reproductive technologies (ARTs) allow to overcome the incapacity of these patients' spermatozoa to fertilize the oocyte and produce a viable and healthy offspring, but the efficiency of the different techniques has still the potential to improve. According to the latest reports of the European Society of Human Reproduction and Embryology (ESHRE) and the Centers for Disease Control and Prevention of the United States (CDC), the percentages of deliveries per ART cycle in 2014 and 2016 were 21 and 22%, respectively. Among the reasons for this relatively low efficiency, the quality of the spermatozoa has been pointed out as critical, and the presence of high percentages of DNA-damaged spermatozoa in patients' ejaculates is possibly one of the main factors reducing the ARTs outcomes. Thus, one of the main challenges in reproductive medicine is to ensure the highest quality of the spermatozoa used in ARTs, and specifically, in terms of genetic integrity. The latest techniques for the preparation and selection of human spermatozoa are herein discussed focusing on those proven to improve one or several of the following parameters: sperm genetic integrity, fertilization capacity, embryo production, and in vitro survival, as well as pregnancy and delivery rates following in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In addition, we discuss the potential of techniques developed in non-human mammals that could be further transferred to the clinic.
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Affiliation(s)
| | - Sara Ruiz-Díaz
- Mistral Fertility Clinics S.L., Clínica Tambre, Madrid, Spain
- Department of Animal Reproduction, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Madrid, Spain
| | - Priscila Ramos-Ibeas
- Department of Animal Reproduction, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Madrid, Spain
| | - Serafín Pérez-Cerezales
- Department of Animal Reproduction, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Madrid, Spain
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Miller D. Hyaluronan-selected sperm should not be considered an add-on - Author's reply. Lancet 2019; 394:1320. [PMID: 31609219 DOI: 10.1016/s0140-6736(19)31248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/10/2019] [Indexed: 10/25/2022]
Affiliation(s)
- David Miller
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds Laboratories, Leeds LS2 9JT, UK.
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Lepine S, McDowell S, Searle LM, Kroon B, Glujovsky D, Yazdani A. Advanced sperm selection techniques for assisted reproduction. Cochrane Database Syst Rev 2019; 7:CD010461. [PMID: 31425620 PMCID: PMC6699650 DOI: 10.1002/14651858.cd010461.pub3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Assisted reproductive technologies (ART) including in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), combine gametes to enhance the probability of fertilisation and pregnancy. Advanced sperm selection techniques are increasingly employed in ART, most commonly in cycles utilising ICSI. Advanced sperm selection techniques are proposed to improve the chance that structurally intact and mature sperm with high DNA integrity are selected for fertilisation. Strategies include selection according to surface charge; sperm apoptosis; sperm birefringence; ability to bind to hyaluronic acid; and sperm morphology under ultra-high magnification. These techniques are intended to improve ART outcomes. OBJECTIVES To evaluate the effectiveness and safety of advanced sperm selection techniques on ART outcomes. SEARCH METHODS We conducted a systematic search of electronic databases (Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL via the Cochrane Register of Studies Online, MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL); trials registers (ClinicalTrials.gov, Current Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform); conference abstracts (Web of Knowledge); and grey literature (OpenGrey) for relevant randomised controlled trials (RCTs). We handsearched the reference lists of included studies and similar reviews. The search was conducted in June 2018. SELECTION CRITERIA We included RCTs comparing advanced sperm selection techniques versus standard IVF, ICSI, or another technique. We excluded studies of intracytoplasmic morphologically selected sperm injection (IMSI), as they are subject to a separate Cochrane Review. Primary outcomes measured were live birth and miscarriage per woman randomly assigned. Secondary outcome measures included clinical pregnancy per woman randomly assigned. Secondary adverse events measured included miscarriage per clinical pregnancy and foetal abnormality. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and risk of bias and extracted data. Any disagreements were resolved by consultation with a third review author. We consulted study investigators to resolve queries. Risk ratios (RRs) were calculated with 95% confidence intervals (CIs). We combined studies using a fixed-effect model. We evaluated the quality of the evidence using GRADE methods. MAIN RESULTS We included eight RCTs (4147 women). The quality of evidence ranged from very low to low. The main limitations were imprecision, performance bias, and attrition bias.Hyaluronic acid selected sperm-intracytoplasmic sperm injection (HA-ICSI) compared to ICSITwo RCTs compared the effects of HA-ICSI versus ICSI on live birth. The quality of the evidence was low. There may be little or no difference between groups: 25% chance of live birth with ICSI versus 24.5% to 31% with HA-ICSI (RR 1.09, 95% CI 0.97 to 1.23, 2903 women, I2 = 0%, low-quality evidence). Three RCTs reported on miscarriage. HA-ICSI may decrease miscarriage per woman randomly assigned: 7% chance of miscarriage with ICSI versus 3% to 6% chance with HA-ICSI (RR 0.61, 95% CI 0.45 to 0.83, 3005 women, I2 = 0%, low-quality evidence) and per clinical pregnancy: 20% chance of miscarriage with ICSI compared to 9% to 16% chance with HA-ICSI (RR 0.62, 95% CI 0.46 to 0.82, 1065 women, I2 = 0%, low-quality evidence). Four RCTs reported on clinical pregnancy. There may be little or no difference between groups: 37% chance of pregnancy with ICSI versus 34% to 40% chance with HA-ICSI (RR 1.00, 95% CI 0.92 to 1.09, 3492 women, I2 = 0%, low-quality evidence).HA-ICSI compared to SpermSlowOne RCT compared HA-ICSI to SpermSlow. The quality of the evidence was very low. We are uncertain whether HA-ICSI improves live birth compared to SpermSlow (RR 1.13, 95% CI 0.64 to 2.01, 100 women) or clinical pregnancy (RR 1.05, 95% CI 0.66 to 1.68, 100 women). We are uncertain whether HA-ICSI reduces miscarriage per woman (RR 0.80, 95% CI 0.23 to 2.81, 100 women) or per clinical pregnancy (RR 0.76, 95% CI 0.24 to 2.44, 41 women).Magnetic-activated cell sorting (MACS) compared to ICSIOne RCT compared MACS to ICSI for live birth; three reported clinical pregnancy; and two reported miscarriage. The quality of the evidence was very low. We are uncertain whether MACS improves live birth (RR 1.95, 95% CI 0.89 to 4.29, 62 women) or clinical pregnancy (RR 1.05, 95% CI 0.84 to 1.31, 413 women, I2 = 81%). We are also uncertain if MACS reduces miscarriage per woman (RR 0.95, 95% CI 0.16 to 5.63, 150 women, I2 = 0%) or per clinical pregnancy (RR 0.51, 95%CI 0.09 to 2.82, 53 women, I2=0)Zeta sperm selection compared to ICSIOne RCT evaluated Zeta sperm selection. The quality of the evidence was very low. We are uncertain of the effect of Zeta sperm selection on live birth (RR 2.48, 95% CI 1.34 to 4.56, 203 women) or clinical pregnancy (RR 1.82, 95% CI 1.20 to 2.75, 203 women). We are also uncertain if Zeta sperm selection reduces miscarriage per woman (RR 0.73, 95% CI 0.16 to 3.37, 203 women) or per clinical pregnancy (RR 0.41, 95% CI 0.10 to 1.68, 1 RCT, 62 women).MACS compared to HA-ICSIOne RCT compared MACS to HA-ICSI. This study did not report on live birth. The quality of the evidence was very low. We are uncertain of the effect on miscarriage per woman (RR 1.52, 95% CI 0.10 to 23.35, 78 women) or per clinical pregnancy (RR 1.06, 95% CI 0.07 to 15.64, 37 women). We are also uncertain of the effect on clinical pregnancy (RR 1.44, 95% CI 0.91 to 2.27, 78 women). AUTHORS' CONCLUSIONS The evidence suggests that sperm selected by hyaluronic acid binding may have little or no effect on live birth or clinical pregnancy but may reduce miscarriage. We are uncertain of the effect of Zeta sperm selection on live birth, clinical pregnancy, and miscarriage due principally to the very low quality of the evidence for this intervention. We are uncertain of the effect of the other selection techniques on live birth, miscarriage, or pregnancy.Further high-quality studies, including the awaited data from the identified ongoing studies, are required to evaluate whether any of these advanced sperm selection techniques can be recommended for use in routine practice.
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Affiliation(s)
- Sam Lepine
- Capital and Coast District Health BoardDepartment of Obstetrics and GynaecologyWellingtonNew Zealand
| | - Simon McDowell
- Queensland Fertility Group Research Foundation55 Little Edward St, Level 2 Boundary CourtSpring HillBrisbaneQueenslandAustralia4000
| | - Leigh M Searle
- Royal Women's HospitalReproductive ServicesMelbourneAustralia
| | - Ben Kroon
- Queensland Fertility Group Research Foundation55 Little Edward St, Level 2 Boundary CourtSpring HillBrisbaneQueenslandAustralia4000
- The University of QueenslandBrisbaneQueenslandAustralia4072
| | - Demián Glujovsky
- CEGYR (Centro de Estudios en Genética y Reproducción)Reproductive MedicineViamonte 1432,Buenos AiresArgentina
| | - Anusch Yazdani
- Queensland Fertility Group Research Foundation55 Little Edward St, Level 2 Boundary CourtSpring HillBrisbaneQueenslandAustralia4000
- The University of QueenslandBrisbaneQueenslandAustralia4072
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Jeyendran RS, Caroppo E, Rouen A, Anderson A, Puscheck E. Selecting the most competent sperm for assisted reproductive technologies. Fertil Steril 2019; 111:851-863. [DOI: 10.1016/j.fertnstert.2019.03.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 12/27/2022]
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Vaughan DA, Sakkas D. Sperm selection methods in the 21st century. Biol Reprod 2019; 101:1076-1082. [DOI: 10.1093/biolre/ioz032] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract
Natural sperm selection in humans is a rigorous process resulting in the highest quality sperm reaching, and having an opportunity to fertilize, the oocyte. Relative to other mammalian species, the human ejaculate consists of a heterogeneous pool of sperm, varying in characteristics such as shape, size, and motility. Semen preparation in assisted reproductive technologies (ART) has long been performed using either a simple swim-up method or density gradients. Both methodologies provide highly motile sperm populations; however neither replicates the complex selection processes seen in nature. A number of methods have now been developed to mimic some of the natural selection processes that exist in the female reproductive tract. These methods attempt to select a better individual, or population of, spermatozoa when compared to classical methods of preparation. Of the approaches already tested, platforms based upon sperm membrane markers, such as hyaluronan or annexin V, have been used to either select or deselect sperm with varied success. One technology that utilizes the size, motility, and other characteristics of sperm to improve both semen analysis and sperm selection is microfluidics. Here, we sought to review the efficacy of both available and emerging techniques that aim to improve the quality of the sperm pool available for use in ART.
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Affiliation(s)
- Denis A Vaughan
- Boston IVF, Waltham, Massachusetts, USA
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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22
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Miller D, Pavitt S, Sharma V, Forbes G, Hooper R, Bhattacharya S, Kirkman-Brown J, Coomarasamy A, Lewis S, Cutting R, Brison D, Pacey A, West R, Brian K, Griffin D, Khalaf Y. Physiological, hyaluronan-selected intracytoplasmic sperm injection for infertility treatment (HABSelect): a parallel, two-group, randomised trial. Lancet 2019; 393:416-422. [PMID: 30712901 PMCID: PMC6409400 DOI: 10.1016/s0140-6736(18)32989-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/25/2018] [Accepted: 11/13/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sperm 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. METHODS This 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. FINDINGS Between 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. INTERPRETATION Compared with ICSI, PICSI does not significantly improve term livebirth rates. The wider use of PICSI, therefore, is not recommended at present. FUNDING National Institute for Health Research Efficacy and Mechanism Evaluation Programme.
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Affiliation(s)
- David Miller
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds Laboratories, University of Leeds, Leeds, UK.
| | - Susan Pavitt
- Dental Translational and Clinical Research Unit, Leeds National Institute for Health Research Clinical Research Facility, University of Leeds, Leeds, UK
| | - Vinay Sharma
- The Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds, UK
| | - Gordon Forbes
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Richard Hooper
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Siladitya Bhattacharya
- School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jackson Kirkman-Brown
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Women's Hospital, Birmingham Women's and Children's National Health Service (NHS) Foundation Trust, Birmingham, UK
| | - Arri Coomarasamy
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Women's Hospital, Birmingham Women's and Children's National Health Service (NHS) Foundation Trust, Birmingham, UK
| | | | | | - Daniel Brison
- Department of Reproductive Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
| | - Allan Pacey
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Brian
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Darren Griffin
- School of Biosciences, University of Kent, Canterbury, UK
| | - Yakoub Khalaf
- Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
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Tarozzi N, Nadalini M, Borini A. Effect on Sperm DNA Quality Following Sperm Selection for ART: New Insights. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:169-187. [DOI: 10.1007/978-3-030-21664-1_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Casillas F, Betancourt M, Cuello C, Ducolomb Y, López A, Juárez-Rojas L, Retana-Márquez S. An efficiency comparison of different in vitro fertilization methods: IVF, ICSI, and PICSI for embryo development to the blastocyst stage from vitrified porcine immature oocytes. Porcine Health Manag 2018; 4:16. [PMID: 30123521 PMCID: PMC6088397 DOI: 10.1186/s40813-018-0093-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022] Open
Abstract
Background Most studies carried out to evaluate recovery and development after porcine oocyte vitrification, reported better rates when cryopreserved in embryonic development stages or zygotes, but not in immature oocytes. For this reason, many studies are performed to improve immature oocyte vitrification protocols testing the use of different cryoprotectant concentrations, cooling devices, incubation times; but only a few of them have evaluated which fertilization procedure enhances blastocyst rates in vitrified oocytes. Therefore, this study was aimed to evaluate: 1) if the sperm selection with hyaluronic acid (HA) or polyvinylpyrrolidone (PVP) before injection could play a key role in increasing fertilization and blastocyst formation and 2) the embryo developmental ability and blastocyst production of porcine immature oocytes retrieved after vitrification-warming and co-cultured with granulosa cells during IVM, using different fertilization techniques: in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and conventional ICSI with hyaluronic acid (HA) sperm selection, known as physiological intracytoplasmic sperm injection (PICSI) and. Results Sperm selected with HA-PICSI displayed a higher percentage of live/acrosome reacted status compared to those in control and exposed to PVP. Higher dead/acrosome reacted rates were obtained after PVP exposure compared to control and HA. In oocytes, viability significantly decreased after IVM in vitrified oocytes. Besides, IVM rates were not different between control denuded oocytes cultured with granulosa cells (DO-GC) and vitrified oocytes. Regarding fertilization parameters, IVF showed higher percentages of total fertilization rate than those obtained by ICSI and PICSI. However, results demonstrate that PICSI fertilization increased the blastocysts formation rate in control DO-GC and vitrified oocytes compared to IVF and ICSI. Conclusions To achieve high blastocyst formation rates from vitrified GV oocytes, it is recommended that sperm should be selected with HA instead of PVP before injection since high viability and acrosome reaction rates were obtained. Also, PICSI fertilization was the best method to produce higher blastocyst rates compared to the IVF and ICSI procedures.
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Affiliation(s)
- Fahiel Casillas
- 1Departamento de Biología de la Reproducción, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, 09340 CDMX, Mexico.,2Doctorado en Ciencias Biológicas y de la Salud. Universidad Autónoma Metropolitana-Iztapalapa, 09340 CDMX, Mexico
| | - Miguel Betancourt
- 3Departamento de Ciencias de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, 09340 CDMX, Mexico
| | - Cristina Cuello
- 4Departamento de Medicina y Cirugía Animal, Universidad de Murcia, 30100 Espinardo, Spain
| | - Yvonne Ducolomb
- 3Departamento de Ciencias de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, 09340 CDMX, Mexico
| | - Alma López
- 3Departamento de Ciencias de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, 09340 CDMX, Mexico
| | - Lizbeth Juárez-Rojas
- 1Departamento de Biología de la Reproducción, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, 09340 CDMX, Mexico
| | - Socorro Retana-Márquez
- 1Departamento de Biología de la Reproducción, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, 09340 CDMX, Mexico
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Avalos-Durán G, Cañedo-Del Ángel AME, Rivero-Murillo J, Zambrano-Guerrero JE, Carballo-Mondragón E, Checa-Vizcaíno MÁ. Physiological ICSI (PICSI) vs. Conventional ICSI in Couples with Male Factor: A Systematic Review. JBRA Assist Reprod 2018; 22:139-147. [PMID: 29672006 PMCID: PMC5982561 DOI: 10.5935/1518-0557.20180027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine the efficacy of the physiological ICSI technique (PICSI) vs. conventional ICSI in the prognosis of couples, with respect to the following outcome measures: live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage rates. METHODS A systematic review of the literature, extracting raw data and performing data analysis. Patient(s): Couples with the male factor, who were subjected to in-vitro fertilization. Main Outcome Measures: rates of live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage. RESULTS In the systematic search, we found 2,918 studies and an additional study from other sources; only two studies fulfilled the inclusion criteria for this systematic review. The rates of live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage were similar for both groups. CONCLUSION There is no statistically significant difference between PICSI vs. ICSI, for any of the outcomes analyzed in this study. Enough information is still not available to prove the efficacy of the PICSI technique over ICSI in couples with male factor.
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Affiliation(s)
- Georgina Avalos-Durán
- Laboratorio de Fertilización In-Vitro, Clínica de infertilidad y Reproducción Asistida de Toluca, IN-FIV, Metepec, Estado de México, México
| | | | - Juana Rivero-Murillo
- Departamento de Medicina Reproductiva, URH, Unidad de Reproducción Humana, Quito, Ecuador
| | | | - Esperanza Carballo-Mondragón
- Laboratorio de Fertilización In-Vitro, Centro Mexicano de Fertilidad Dr. Alberto Kably, Estado de México, México
| | - Miguel Ángel Checa-Vizcaíno
- Departamento de Ginecología y Obstetricia, Hospital del Mar, Hospital Universitario del Mar, Universidad Autónoma de Barcelona, Barcelona, España
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Roychoudhury S, Maldonado-Rosas I, Agarwal A, Esteves SC, Henkel R, Sharma R. Human sperm handling in intracytoplasmic sperm injection processes: In vitro studies on mouse oocyte activation, embryo development competence and sperm oxidation-reduction potential. Andrologia 2018; 50:e12943. [PMID: 29315724 DOI: 10.1111/and.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 02/28/2024] Open
Abstract
Polyvinylpyrrolidone (PVP) and hyaluronic acid (HA) are routinely used in handling spermatozoa for intracytoplasmic sperm injection (ICSI). As there are still concerns about possible adverse effects on the embryo, this study investigated sperm handling in a mouse ICSI model to (i) evaluate oocyte activation after injection of spermatozoa selected for rotational or linear motion in PVP; (ii) assess the effect of sperm selection in PVP, HA and medium on oocyte activation; (iii) examine the effects of PVP and HA on parthenogenetic oocyte activation and embryo development; and (iv) assess the oxidation-reduction potential (ORP) of spermatozoa exposed to PVP, HA or medium. Oocyte activation was higher when spermatozoa exhibited rotational motion rather than linear motion (79% vs. 52%; p = .05). There was no difference in oocyte activation and embryo development after parthenogenetic oocyte activation after sperm injection using PVP, HA or medium-incubated spermatozoa. PVP-selected spermatozoa exhibited lower (p < .0001) ORP levels than using HA. Thus, results indicate that the sperm handling method and the type of medium used impact ICSI outcomes. Overall, sperm incubation in PVP, HA and medium yields similar outcomes with regard to oocyte activation and embryo development. However, PVP provides more antioxidative protection than HA and should therefore be preferred for sperm manipulation.
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Affiliation(s)
- S Roychoudhury
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Life Science and Bioinformatics, Assam University, Silchar, India
| | | | - A Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - S C Esteves
- ANDROFERT, Center for Male Reproduction, Campinas, Brazil
| | - R Henkel
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - R Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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27
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Liu Y, Feenan K, Chapple V, Roberts P, Matson P. Intracytoplasmic sperm injection using hyaluronic acid or polyvinylpyrrolidone: a time-lapse sibling oocyte study. HUM FERTIL 2017; 22:39-45. [DOI: 10.1080/14647273.2017.1366077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yanhe Liu
- Fertility North, Joondalup, Australia
- Systems and Intervention Research Centre for Health (SIRCH), School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | | | - Peter Roberts
- Systems and Intervention Research Centre for Health (SIRCH), School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Phillip Matson
- Fertility North, Joondalup, Australia
- Systems and Intervention Research Centre for Health (SIRCH), School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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28
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Jeve YB, Potdar N, Blower JA, Gelbaya T. Strategies to improve fertilisation rates with assisted conception: a systematic review. HUM FERTIL 2017; 21:229-247. [PMID: 28545312 DOI: 10.1080/14647273.2017.1324182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Successful fertilisation is one of the key steps determining success of assisted conception. Various factors including sperm or oocyte pathology and environmental factors have a significant impact on fertilisation rates. This systematic review is aimed to evaluate the existing evidence about factors affecting fertilisation and strategies to improve fertilisation rates. A literature search was performed using Ovid MEDLINE ® (Jan 1950-April 2016), EMBASE (Jan 1950-April 2016), Ovid OLDMEDLINE ®, Pre-MEDLINE (Jan 1950-April 2016) and the Cochrane Library. Relevant key words were used to combine sets of results and a total 243 papers were screened. Only qualitative analysis was performed, as there was major heterogeneity in study design and methodology for quantitative synthesis. Factors affecting fertilisation were divided into sperm- and oocyte-related factors. The methods to improve fertilisation rates were grouped together based on the approach used to improve fertilisation rates. Optimising laboratory condition and procedural effects in techniques is associated with improved fertilisation rates. Various techniques are described to improve fertilisation rates including assisted oocyte activation, physiological intracytoplasmic sperm injection (PICSI) and intracytoplasmic morphologically selected sperm injection (IMSI). This review highlights the promising strategies under research to enhance fertilisation rates. Adequately powered multicentre randomised trials are required to evaluate these techniques before considering clinical application.
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Affiliation(s)
- Yadava Bapurao Jeve
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK
| | - Neelam Potdar
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK.,b Reproductive Sciences Section , University of Leicester , Leicester , UK
| | - Jane A Blower
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK
| | - Tarek Gelbaya
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK
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Erberelli RF, Salgado RM, Pereira DHM, Wolff P. Hyaluronan-binding system for sperm selection enhances pregnancy rates in ICSI cycles associated with male factor infertility. JBRA Assist Reprod 2017; 21:2-6. [PMID: 28333023 PMCID: PMC5365191 DOI: 10.5935/1518-0557.20170002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The aim of the present study was to compare two procedures for sperm selection in ICSI cycles - conventional morphology sperm selection (ICSI-PVP) and chemical selection through Hyaluronan-treated petri dishes (PICSI), when male factor was associated. METHODS The evaluated parameters were semen quality, fertilization and cleavage rates, chemical and clinical pregnancy rates, as well as abortion rate. Fifty-six ICSI cycles were included in this report, 19 cycles using PICSI and 37 using conventional ICSI. RESULTS PICSI and ICSI showed, respectively, the following outcome: fertilization rates 71.93% (123/171) and 64.14% (127/198); cleavage rates 95.12% (117/123) and 95.27% (121/127); chemical pregnancy rates 63.15% (12/19) and 27.03% (10/37); clinical pregnancy rates 42.10% (8/19) and 16.21% (6/37); and abortion rates 33.33% (4/12) and 40.00% (4/10). According to both Fisher's Exact Test and Chi-square Test, chemical pregnancy (p = 0.05) and clinical pregnancy (p = 0.09) rates were significantly higher in the PICSI group. p values ≤ 0.05 were consider statistically significant. CONCLUSIONS The present data indicates that ICSI cycles that used the PICSI technique had a considerably higher chance (≈5 fold) to achieve pregnancy than those who had sperm selected only by morphology assessment. Teratozoospermic patients were those who benefited most with PICSI. Therefore, the technique should be included in laboratory routine with low cost, avoiding the selection of immature sperm with increased rates of peroxidation and DNA fragmentation. Prospective and randomized studies should be applied to strengthen this suggestion.
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Affiliation(s)
| | - Renato M Salgado
- Clínica Genics - Medicina Reprodutiva e Genômica, São Paulo - Brazil
| | | | - Philip Wolff
- Clínica Genics - Medicina Reprodutiva e Genômica, São Paulo - Brazil
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Sperm processing for advanced reproductive technologies: Where are we today? Biotechnol Adv 2016; 34:578-587. [DOI: 10.1016/j.biotechadv.2016.01.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/24/2016] [Accepted: 01/30/2016] [Indexed: 11/19/2022]
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Milachich T, Shterev A. Are there optimal numbers of oocytes, spermatozoa and embryos in assisted reproduction? JBRA Assist Reprod 2016; 20:142-9. [PMID: 27584608 PMCID: PMC5264380 DOI: 10.5935/1518-0557.20160032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this overview is to discuss the current information about the search for the optimum yield of gametes in assisted reproduction, as one of the major pillars of IVF success. The first topic is focused on the number of male gametes and the possible impact of some genetic traits on these parameters. The number of spermatozoa did not seem to be crucial when there is no severe male factor of infertility. Genetic testing prior to using those sperm cells is very important. Different methods were applied in order to elect the "best" spermatozoa according to specific indications. The next problem discussed is the importance of the number of oocytes collected. Several studies have agreed that "15 oocytes is the perfect number," as the number of mature oocytes is more important. However, if elective single embryo transfer is performed, the optimal number of oocytes will enable a proper embryo selection. The third problem discussed concerns fertility preservation. Many educational programs promote and encourage procreation at maternal ages between 20-35 years, since assisted reproduction is unable to fully overcome the effects of female aging and fertility loss after that age. It is also strongly recommended to ensure a reasonable number of cryopreserved mature oocytes, preferably in younger ages (<35), for which an average of two stimulation cycles are likely required. For embryo cryopreservation, the "freeze all" strategy suggests the vitrification of good embryos, therefore quality is prior to number and patient recruitment for this strategy should be performed cautiously.
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Beck-Fruchter R, Shalev E, Weiss A. Clinical benefit using sperm hyaluronic acid binding technique in ICSI cycles: a systematic review and meta-analysis. Reprod Biomed Online 2016; 32:286-98. [DOI: 10.1016/j.rbmo.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/28/2015] [Accepted: 12/02/2015] [Indexed: 01/09/2023]
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Craciunas L, Tsampras N, Kollmann M, Stirbu L, Raine-Fenning NJ. Use of hyaluronic acid for sperm immobilisation and selection before intracytoplasmic sperm injection: A systematic review and meta-analysis. World J Obstet Gynecol 2015; 4:113-123. [DOI: 10.5317/wjog.v4.i4.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/07/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To appraise critically the published randomised controlled trials (RCTs) reporting on the effectiveness of using hyaluronic acid (HA) for sperm immobilisation and selection before intracytoplasmic sperm injection (ICSI).
METHODS: Two authors used the PICO Method in order to perform a comprehensive literature search of the standard medical databases in June 2015. Data from the included studies was extracted independently by two authors using a predefined pro-forma. Review Manager (RevMan) was used to calculate the combined outcomes where multiple studies contributed with their results. Risk ratio (RR) with a 95%CI using the Mantel-Haenszel method was calculated for binary data variables. Heterogeneity was measured using the χ2 test and quantified using I2. In case of substantial heterogeneity (P < 0.10 for χ2 test or I2 > 50%) the combined outcome was calculated using the random effects model. The results from the meta-analysis were displayed as forest plots. The guideline of the Cochrane Collaboration was used to assess the risk of bias and it was illustrated as a risk of bias graph.
RESULTS: The systematic literature search identified 166 different studies related to sperm immobilisation and selection for ICSI. Eleven RCTs involving 13719 oocyte intracytoplasmatic injections with sperm immobilised and selected using HA or polyvinylpyrrolidone (PVP) were included in this systematic review and meta-analysis. There was low heterogeneity among the included trials (χ2 = 16.86, df = 11, P = 0.11; I2 = 35%). There was no statistical difference between HA and PVP groups in terms of fertilisation rate (RR = 1.01; 95%CI: 0.99-1.03; z = 0.75; P = 0.45), good embryos rate (RR = 1.01; 95%CI: 0.96-1.06; z = 0.30; P = 0.76), live birth rate (RR = 1.15; 95%CI: 0.86-1.54; z = 0.92; P = 0.36), clinical pregnancy rate (RR = 1.04; 95%CI: 0.92-1.17; z = 0.62; P = 0.53) and implantation rate (RR = 1.17; 95%CI: 0.94-1.46; z = 0.40; P = 0.16). The quality of most of the included studies was moderate to poor because of unclear randomisation technique, inadequate allocation concealment and blinding.
CONCLUSION: This systematic review and meta-analysis provides evidence of similar efficiency between using HA or PVP for sperm immobilisation and selection before ICSI.
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Mokánszki A, Tóthné EV, Bodnár B, Tándor Z, Molnár Z, Jakab A, Ujfalusi A, Oláh É. Is sperm hyaluronic acid binding ability predictive for clinical success of intracytoplasmic sperm injection: PICSI vs. ICSI? Syst Biol Reprod Med 2014; 60:348-54. [DOI: 10.3109/19396368.2014.948102] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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