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Zhang X, Chao S, Ye N, Ouyang D. Emerging trends in sperm selection: enhancing success rates in assisted reproduction. Reprod Biol Endocrinol 2024; 22:67. [PMID: 38877490 PMCID: PMC11177495 DOI: 10.1186/s12958-024-01239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024] Open
Abstract
This comprehensive review explores the evolving landscape of sperm selection techniques within the realm of Assisted Reproductive Technology (ART). Our analysis delves into a range of methods from traditional approaches like density gradient centrifugation to advanced techniques such as Magnetic-Activated Cell Sorting (MACS) and Intracytoplasmic Morphologically Selected Sperm Injection (IMSI). We critically assess the efficacy of these methods in terms of sperm motility, morphology, DNA integrity, and other functional attributes, providing a detailed comparison of their clinical outcomes. We highlight the transition from conventional sperm selection methods, which primarily focus on physical characteristics, to more sophisticated techniques that offer a comprehensive evaluation of sperm molecular properties. This shift not only promises enhanced prediction of fertilization success but also has significant implications for improving embryo quality and increasing the chances of live birth. By synthesizing various studies and research papers, we present an in-depth analysis of the predictability of different sperm selection procedures in ART. The review also discusses the clinical applicability of these methods, emphasizing their potential in shaping the future of assisted reproduction. Our findings suggest that the integration of advanced sperm selection strategies in ART could lead to more cost-effective treatments with reduced duration and higher success rates. This review aims to provide clinicians and researchers in reproductive medicine with comprehensive insights into the current state and future prospects of sperm selection technologies in ART.
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Affiliation(s)
- Xiang Zhang
- College of Animal Science and Technology, China Agricultural University, Beijing, 100193, China
| | - Shuen Chao
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ningxin Ye
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
- Department of Biology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Dongfang Ouyang
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, M5S 3G8, Canada.
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Garrido N, Gil Juliá M. The Use of Non-Apoptotic Sperm Selected by Magnetic Activated Cell Sorting (MACS) to Enhance Reproductive Outcomes: What the Evidence Says. BIOLOGY 2024; 13:30. [PMID: 38248461 PMCID: PMC10813240 DOI: 10.3390/biology13010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024]
Abstract
Sperm selection of the most competent sperm is a promising way to enhance reproductive outcomes. Apoptosis is the programmed cell death process to maintain tissue homeostasis, and MACS sperm selection of non-apoptotic cells enables the removal of apoptotic sperm from an ejaculate, thus leaving the non-apoptotic available to be microinjected, but given the associated costs of adding these sperm selection steps to the routine practice, there is a need for a careful examination of the literature available to answer questions such as who can benefit from this MACS, how significant this improvement is, and how robust the evidence and data available supporting this choice are. Thus, the aim of this narrative review was to objectively evaluate the available evidence regarding the potential benefits of the use of MACS. From the literature, there are controversial results since its implementation as an in vitro fertilization add-on, and this may be explained in part by the low quality of the evidence available, wrong designs, or even inadequate statistical analyses. We concluded that the benefits of adding MACS are unclear, and further methodologically sound research on specific populations is much needed before offering it clinically.
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Affiliation(s)
- Nicolás Garrido
- IVIRMA Global Research Alliance, IVI Foundation, Andrology and Male Infertility Research Group, IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Tower A, 1st Floor, 46026 Valencia, Spain;
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Karabulut S, Camcı İY, Atambay C, Yiğit P, Keskin İ. Sperm selection with Annexin-V coated polystrene bead technique (APB-Tech): A novel and reliable method for the microscopic selection of viable and non-apoptotic sperm to be used for intracytoplasmic sperm injection. Theriogenology 2022; 194:92-103. [PMID: 36209549 DOI: 10.1016/j.theriogenology.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/01/2022] [Accepted: 09/26/2022] [Indexed: 10/14/2022]
Abstract
Infertility is a growing health problem that affects 20% of couples who want to conceive. 'Intracytoplasmic sperm injection' (ICSI) is a commonly used assisted reproduction treatment technique that offers the couples to overcome a wide variety of infertility reasons, including female, male and unexplained infertility. A crucial step in ICSI is choosing the correct sperm with the highest potential to form a healthy embryo and thus a healthy offspring. The sperm selection strategies aim to obtain a sperm population with better motility and morphology, which are insufficient to predict a sperm's reproductive potential. The elimination of apoptotic sperms, which is shown to be higher in infertile males and which is shown to affect embryo development and reproductive cohort significantly should also be included in the selection strategies. Among all sperm selection methods, there are only a few which can eliminate apoptotic sperm, but because they need extra types of equipments, a long training period, and high costs, they couldn't find place in the most commonly used techniques in an IVF lab. Selecting the non-apoptotic sperm cells will help us choose a sperm that is more likely to be chosen by the natural selection mechanisms and thus will help to mimic the natural conception more. The study aimed to develop a novel, easy and a harmless individual sperm selection technique to enable choosing non-apoptotic viable sperm cells via light microscopy without any need for extra equipment, education and cost to be used for ''ICSI'. The technique is based on the binding ability of Annexin-V covered polystrene beads to the externalized phosphatidylserine at the outer leaflet of an apoptotic sperm's plasma membrane. After Annexin-V covered polystyrene beads were prepared, beads obtained were attached to BALB-c mice sperm, and the technique is optimized to obtain the most efficient attachment conditions. The results are then compared with the results of four well-known reliable apoptosis detection techniques to test the validity and sperm survival test to test the toxicity of the technique. The method is proven to be '''reliable' by comparing it with the results of well-known techniques, including TUNEL and SCSA (sperm chromatin structure assay), and '''safe' by showing its non-toxicity via sperm survival test (SST). In addition, the method enables the selection of sperm cells more closer to naturally-chosen ones from a pool of sperm that should not be allowed to be randomly chosen during microinjection. To date, it was impossible to distinguish a non-apoptotic sperm without harming it or without needing additional equipment other than a routine IVF lab and extra training other than routine andrology work. The technique is named as 'Annexin-V coated polystyrene bead technique (APB-Tech)'. Based on our results, further studies on APB-Tech should be focused on the possible improvement of ICSI outcomes and, thus, success rates.
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Affiliation(s)
- Seda Karabulut
- Istanbul Medipol University, School of Medicine, Department of Histology and Embryology, Beykoz, Istanbul, Turkey; Health Science and Technologies Research Institute (SABİTA), Beykoz, Istanbul, Turkey.
| | - İrem Yalım Camcı
- Gebze Technical University, Department of Molecular Biology and Genetics, Kocaeli, Turkey.
| | - Can Atambay
- Istanbul Medipol University, School of Medicine, Department of Histology and Embryology, Beykoz, Istanbul, Turkey; Health Science and Technologies Research Institute (SABİTA), Beykoz, Istanbul, Turkey.
| | - Pakize Yiğit
- Istanbul Medipol University, School of Medicine, Department of Histology and Embryology, Beykoz, Istanbul, Turkey; Health Science and Technologies Research Institute (SABİTA), Beykoz, Istanbul, Turkey.
| | - İlknur Keskin
- Istanbul Medipol University, School of Medicine, Department of Histology and Embryology, Beykoz, Istanbul, Turkey; Health Science and Technologies Research Institute (SABİTA), Beykoz, Istanbul, Turkey.
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Gil Juliá M, Hervás I, Navarro-Gomezlechon A, Quintana F, Amorós D, Pacheco A, González-Ravina C, Rivera-Egea R, Garrido N. Cumulative live birth rates in donor oocyte ICSI cycles are not improved by magnetic-activated cell sorting sperm selection. Reprod Biomed Online 2022; 44:677-684. [PMID: 35184950 DOI: 10.1016/j.rbmo.2021.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/25/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
RESEARCH QUESTION Does magnetic-activated cell sorting (MACS) for sperm selection increase cumulative live birth rates (CLBR) or improve clinical parameters of reproductive success in couples undergoing intracytoplasmic sperm injection (ICSI) with donor oocytes? DESIGN Retrospective multicentre observational study including data compiled from unselected couples who underwent ICSI cycles with donated oocytes in 15 Spanish IVIRMA fertility clinics (January 2008 to February 2020). Patients were divided into reference (standard semen processing, n = 40,157) and MACS (additional sperm selection step by MACS, n = 1,240) groups. CLBR were plotted on Kaplan-Meier curves and compared using the Mantel-Cox test. Proportions were compared with a generalized estimating equation model, and results were adjusted to clinically relevant variables. RESULTS The MACS group showed a 27.1% CLBR after one embryo was transferred and 81.6% after four; the reference group had CLBR of 19.6% and 78.5%, respectively. CLBR in the MACS group was 4.2% after five oocytes were used and 75.5% after 15; for the reference group, CLBR were 7.8% and 78.3%, respectively. Kaplan-Meier curves showed statistically significant differences in CLBR per number of embryos transferred and per number of donated metaphase II oocytes between the two groups (both P < 0.0001), but not for CLBR per embryo transfer. No significant differences between groups were found for classical clinical outcomes such as pregnancy and live birth rates per embryo transfer. CONCLUSIONS Although MACS sperm selection slightly increased the CLBR per embryo transferred compared with the reference group, this change was not clinically meaningful. MACS should not be recommended indiscriminately to all infertile patients undergoing ICSI with donated oocytes as a sperm processing add-on.
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Affiliation(s)
- María Gil Juliá
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain.
| | - Irene Hervás
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain
| | - Ana Navarro-Gomezlechon
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain
| | - Fernando Quintana
- IVIRMA Bilbao, Landabarri Bidea, 1-3, Planta 2ª, Leioa Bizkaia 48940, Spain
| | - David Amorós
- IVIRMA Barcelona, Ronda del General Mitre, 14, Barcelona 08017, Spain
| | | | | | | | - Nicolás Garrido
- IVI Foundation - IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Torre A, Planta 1ª, Valencia . 46026, Spain
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Gil Juliá M, Hervás I, Navarro-Gómez Lechón A, Quintana F, Amorós D, Pacheco A, González-Ravina C, Rivera-Egea R, Garrido N. Sperm Selection by Magnetic-Activated Cell Sorting before Microinjection of Autologous Oocytes Increases Cumulative Live Birth Rates with Limited Clinical Impact: A Retrospective Study in Unselected Males. BIOLOGY 2021; 10:biology10050430. [PMID: 34066115 PMCID: PMC8150702 DOI: 10.3390/biology10050430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
Simple Summary Many couples attending infertility clinics still need to repeat treatments and undergo several failed attempts before achieving a healthy newborn, which leaves room for improvement in the techniques we currently use in the clinic. Among the different procedures susceptible to improvement, the selection of the most adequate sperm to be injected inside the egg is crucial to the cycle’s success. Magnetic-activated cell sorting (MACS) is a technique that removes physiologically abnormal sperm that have started a programmed cell death (apoptotic) process from a semen sample. However, it is not recommended to all patients because there is no agreement between the published literature on whether it improves reproductive outcomes. This study used data from all intracytoplasmic sperm injection cycles performed using the patient’s own oocytes in our clinics from January 2008 to February 2020. Our findings support that MACS should not be recommended to all infertile couples, since there was no significant difference in results compared to treatments in which MACS was not used. This study provides clinicians and patients with more accurate information on how MACS will impact their chances of pregnancy, and it will lead to studies focused on specific populations to which the technique can be particularly helpful. Abstract The application of MACS non-apoptotic sperm selection in infertility clinics is controversial since the published literature does not agree on its effect on reproductive outcomes. Therefore, it is not part of the routine clinical practice. Classical measures of reproductive success (pregnancy or live birth rates per ovarian stimulation) introduce a bias in the evaluation of a technique’s effect, since only the best embryo is transferred. This retrospective, multicenter, observational study evaluated the impact of MACS on reproductive outcomes, measuring results in classical parameters and cumulative live birth rates (CLBR). Data from ICSI cycles using autologous oocyte in Spanish IVIRMA fertility clinics from January 2008 to February 2020 were divided into two groups according to their semen processing: standard practice (reference: 46,807 patients) versus an added MACS sperm selection (1779 patients). Only when measured as CLBR per embryo transferred and per MII oocyte used was the difference between groups statistically significant. There were no significant differences between MACS and reference groups on pregnancy and live birth rates. In conclusion, results suggest that non-apoptotic sperm selection by MACS on unselected males prior to ICSI with autologous oocytes has limited clinical impact, showing a subtle increase in CLBR per embryo transferred.
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Affiliation(s)
- María Gil Juliá
- Andrology and Male Infertility Research Group, IVI Foundation—IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Tower A, 1st Floor, 46026 Valencia, Spain; (I.H.); (A.N.-G.L.); (N.G.)
- Correspondence:
| | - Irene Hervás
- Andrology and Male Infertility Research Group, IVI Foundation—IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Tower A, 1st Floor, 46026 Valencia, Spain; (I.H.); (A.N.-G.L.); (N.G.)
| | - Ana Navarro-Gómez Lechón
- Andrology and Male Infertility Research Group, IVI Foundation—IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Tower A, 1st Floor, 46026 Valencia, Spain; (I.H.); (A.N.-G.L.); (N.G.)
| | - Fernando Quintana
- IVIRMA Bilbao, Landabarri Bidea, 1–3, 2nd Floor, 48940 Leioa Bizkaia, Spain;
| | - David Amorós
- IVIRMA Barcelona, Ronda del General Mitre, 14, 08017 Barcelona, Spain;
| | | | | | | | - Nicolás Garrido
- Andrology and Male Infertility Research Group, IVI Foundation—IIS La Fe Health Research Institute, Av. Fernando Abril Martorell, 106. Tower A, 1st Floor, 46026 Valencia, Spain; (I.H.); (A.N.-G.L.); (N.G.)
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Sicchieri F, Silva AB, Santana VP, Vasconcelos MAC, Ferriani RA, Vireque AA, Dos Reis RM. Phosphatidylcholine and L-acetyl-carnitine-based freezing medium can replace egg yolk and preserves human sperm function. Transl Androl Urol 2021; 10:397-407. [PMID: 33532327 PMCID: PMC7844480 DOI: 10.21037/tau-20-1004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Conventional cryopreservation methods induce chemical and mechanical damage to the sperm membranes. The cryoprotectant potential of phospholipids of vegetal origin as soybean lecithin has been investigated as a substitute for egg yolk in diluents used for the cryopreservation of human spermatozoa. Therefore, the objective of this study was comparing the efficacy of a synthetic cryoprotectant supplemented with L-α-phosphatidylcholine (PC) and L-acetyl-carnitine (ANTIOX-PC) and the standard egg-based TEST-yolk buffer (TYB) in preserving sperm motility and chromatin quality in cryopreserved semen samples. Methods Prospective experimental study in which semen samples from 63 men with normal sperm motility and 58 men with low sperm motility were included and analyzed both before and after cryopreservation using ANTIOX-PC or TYB freezing media. Sperm quality was evaluated by routine semen analysis and DNA fragmentation index using the Terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Results Differences in the post-thaw progressive motility and DNA fragmentation index were not detected between TYB and ANTIOX-PC cryoprotectants in both normal and low sperm motility groups (P>0.05). However, ANTIOX-PC medium retained higher non-progressive motility and lower percentage of immotile sperm when compared to TYB medium, resulting in a greater total motile sperm count (P<0.05), regardless baseline values of motility characteristic of the normospermic or asthenozoospermic samples. Conclusions ANTIOX-PC medium was effective to protect human sperm during a freeze-thaw cycle compared to the TYB medium. A clinically relevant advantage in better preserving kinetic parameters as higher total motility and lower immotile post-thawed sperm from ANTIOX-PC, in normal and low motility semen samples, demonstrated the positive impact of phospholipid and antioxidant treatment on sperm cryotolerance with high potential for egg yolk lipids replacement and biosafety.
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Affiliation(s)
- Fernanda Sicchieri
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Aline Bomfim Silva
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,National Institutes of Hormones and Woman's Health, CNPq, Brazil
| | - Alessandra Aparecida Vireque
- Invitra - Assisted Reproductive Technologies Ltd., Supera Innovation and Technology Park, Ribeirão Preto, São Paulo, Brazil
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,National Institutes of Hormones and Woman's Health, CNPq, Brazil
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Karimi Zarchi M, Maleki B, Dehghani Ashkezari M, Motamed Zadeh L, Agha-Rahimi A. The Effects of In Vitro Incubation of Asthenoteratozoospermic Semen after Density Gradient Centrifugation at Room Temperature and 37° C on Sperm Parameters, Chromatin Quality and DNA Fragmentation in a Short Time Period. J Reprod Infertil 2020; 21:275-282. [PMID: 33209744 PMCID: PMC7648867 DOI: 10.18502/jri.v21i4.4332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Sperm quality is an important factor in assisted reproductive technology (ART) that affects the success rate of infertile couples treatment. In vitro incubation of sperm can influence its parameters and DNA integrity. The present study focused on the effect of different incubation temperatures sperm parameters on asthenoteratozoospermia semen prepared with density gradient centrifugation at different times. Methods: Twenty-seven samples were collected and prepared. Then, the suspension was divided into two parts. One part was incubated at room temperature (RT), and another was incubated at 37°C. Immediately and after 2 hr (2H) and 4 hr (4H), spermatozoa were evaluated regarding motility, viability, morphology, sperm protamine deficiency, chromatin and DNA fragmentation. Statistical analysis was performed using paired t-test and repeated measures. The p<0.05 was considered statistically significant. Results: Our results showed that following 2 and 4 hr of incubation at RT, sperm progressive motility and viability decreased significantly. Sperm DNA fragmentation increased significantly following 2 and 4 hr of incubation at RT and 37°C. The Trend analysis confirmed that there were no significant differences between sperm parameters and DNA fragmentation after different times at RT and 37°C. Conclusion: Incubation of sperm at RT in comparison to 37°C didn’t preserve sperm parameters and DNA efficiently. Therefore, IVF, ICSI and IUI procedure should be performed in the soonest possible time after sperm preparation.
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Affiliation(s)
- Motahareh Karimi Zarchi
- Department of Biology, Medical Biotechnology Research Center, Ashkezar Branch, Islamic Azad University, Yazd, Iran
| | - Behnam Maleki
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmood Dehghani Ashkezari
- Department of Biology, Medical Biotechnology Research Center, Ashkezar Branch, Islamic Azad University, Yazd, Iran
| | - Leila Motamed Zadeh
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azam Agha-Rahimi
- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Agarwal A, Majzoub A, Baskaran S, Panner Selvam MK, Cho CL, Henkel R, Finelli R, Leisegang K, Sengupta P, Barbarosie C, Parekh N, Alves MG, Ko E, Arafa M, Tadros N, Ramasamy R, Kavoussi P, Ambar R, Kuchakulla M, Robert KA, Iovine C, Durairajanayagam D, Jindal S, Shah R. Sperm DNA Fragmentation: A New Guideline for Clinicians. World J Mens Health 2020; 38:412-471. [PMID: 32777871 PMCID: PMC7502318 DOI: 10.5534/wjmh.200128] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Sperm DNA integrity is crucial for fertilization and development of healthy offspring. The spermatozoon undergoes extensive molecular remodeling of its nucleus during later phases of spermatogenesis, which imparts compaction and protects the genetic content. Testicular (defective maturation and abortive apoptosis) and post-testicular (oxidative stress) mechanisms are implicated in the etiology of sperm DNA fragmentation (SDF), which affects both natural and assisted reproduction. Several clinical and environmental factors are known to negatively impact sperm DNA integrity. An increasing number of reports emphasizes the direct relationship between sperm DNA damage and male infertility. Currently, several assays are available to assess sperm DNA damage, however, routine assessment of SDF in clinical practice is not recommended by professional organizations. This article provides an overview of SDF types, origin and comparative analysis of various SDF assays while primarily focusing on the clinical indications of SDF testing. Importantly, we report four clinical cases where SDF testing had played a significant role in improving fertility outcome. In light of these clinical case reports and recent scientific evidence, this review provides expert recommendations on SDF testing and examines the advantages and drawbacks of the clinical utility of SDF testing using Strength-Weaknesses-Opportunities-Threats (SWOT) analysis.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Chak Lam Cho
- Department of Surgery, Union Hospital, Hong Kong
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Ralf Henkel
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Malaysia
| | - Catalina Barbarosie
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Neel Parekh
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Marco G Alves
- Department of Microscopy, Laboratory of Cell Biology & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Edmund Ko
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Andrology Department, Cairo University, Giza, Egypt
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Parviz Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Rafael Ambar
- Urology Department of Centro Universitario em Saude do ABC, Santo André, Brazil
| | | | - Kathy Amy Robert
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Marzano G, Chiriacò MS, Primiceri E, Dell’Aquila ME, Ramalho-Santos J, Zara V, Ferramosca A, Maruccio G. Sperm selection in assisted reproduction: A review of established methods and cutting-edge possibilities. Biotechnol Adv 2020; 40:107498. [DOI: 10.1016/j.biotechadv.2019.107498] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022]
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Beaud H, Albert O, Robaire B, Rousseau MC, Chan PTK, Delbes G. Sperm DNA integrity in adult survivors of paediatric leukemia and lymphoma: A pilot study on the impact of age and type of treatment. PLoS One 2019; 14:e0226262. [PMID: 31856166 PMCID: PMC6922400 DOI: 10.1371/journal.pone.0226262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/23/2019] [Indexed: 11/19/2022] Open
Abstract
Childhood cancer survivors (CCS) are more likely than siblings to report low sperm count and to use assisted reproductive technologies. Yet, it is still unclear if the sperm produced many years after remission of cancer display DNA and chromatin damage linked to male infertility and poor embryo development. As well, the importance of the age at diagnosis in relation to puberty is poorly understood. In this pilot study, we compared reproductive parameters and sperm damage from adult survivors of childhood leukemia and lymphoma, sub-divided into those diagnosed before or after puberty, to men with no history of cancer. Our data indicate that CCS, independently of the age of diagnosis, have a high risk of low sperm count and when sperm are present, chances of DNA and chromatin abnormalities appear similar to those seen in the general population. Exposure to alkylating agents is correlated with low sperm count whereas exposure to anthracyclines, and doxorubicin in particular, could have long-term consequences on sperm integrity. This study highlights the need for further research on fertility among male CCS and the importance of informing families about the potential long-term impact of chemotherapy on male fertility regardless of age at diagnosis.
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Affiliation(s)
- Hermance Beaud
- INRS-Centre Armand-Frappier Santé Biotechnologie, Laval, Quebec, Canada
| | - Océane Albert
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec Canada
| | - Bernard Robaire
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec Canada
- Department of Obstetrics & Gynecology, McGill University, Montreal, Quebec, Canada
| | | | - Peter T. K. Chan
- Division of Urology, McGill University Health Center, Montreal, Quebec, Canada
| | - Geraldine Delbes
- INRS-Centre Armand-Frappier Santé Biotechnologie, Laval, Quebec, Canada
- * E-mail:
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11
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El Fekih S, Tous C, Gueganic N, Brugnon F, Ali HB, Bujan L, Moinard N, Caire-Tetauru E, Ajina M, Douet-Guilbert N, Morel F, Perrin A. Decrease of spermatozoa with an unbalanced chromosome content after cell sorting in men carrying a structural chromosomal abnormality. Andrology 2019; 8:181-190. [PMID: 31116011 DOI: 10.1111/andr.12643] [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: 01/22/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND We showed that in men with a constitutional chromosomal abnormality, DNA fragmentation was significantly higher in chromosomally unbalanced spermatozoa than in spermatozoa with a normal or balanced chromosomal content. These results could be explained by a phenomenon already described in infertile men: abortive apoptosis. OBJECTIVES To determine whether magnetic-activated cell separation could select spermatozoa with lower levels of DNA fragmentation and unbalanced chromosome content in men carrying a structural chromosomal abnormality. MATERIALS AND METHODS The spermatozoa of ten males with a chromosomal rearrangement were separated into two populations using magnetic-activated cell separation (annexin V (-) and annexin V (+) fractions), in order to study meiotic segregation by fluorescence in situ hybridization, the percentage of spermatozoa with an externalization of phosphatidylserine by annexin V staining and DNA fragmentation by TdT-mediated dUTP nick-end labeling on the whole ejaculate and on selected spermatozoa in the same patient. RESULTS For all patients, the percentage of spermatozoa with externalization of phosphatidylserine decreased in the annexin V (-) fraction and increased in the annexin V (+) fraction as compared to the frozen-thawed semen sample. The rates of DNA fragmentation were statistically much lower in the annexin V (-) fraction when compared to the rate before magnetic-activated cell separation for all but one patient. Conversely, we observed a statistically significantly higher rate of DNA fragmentation in the annexin V (+) fraction for six patients. After magnetic-activated cell separation, there was a significant increase of normal/balanced spermatozoa in the fraction of annexin V (-) for all patients. Conversely, we observed a significant decrease in the fraction of annexin V (+) for seven patients. DISCUSSION AND CONCLUSIONS Magnetic-activated cell separation is a promising tool for increasing the selection of healthy spermatozoa, with a decrease in the number of spermatozoa with externalization of phosphatidylserine, DNA fragmentation, and chromosome unbalance, for use in assisted reproductive technologies such as intracytoplasmic sperm injection for males with a chromosomal structural abnormality.
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Affiliation(s)
- S El Fekih
- Laboratoire d'histologie, Embryologie et Cytogénétique, INSERM U1078, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France.,Laboratoire de Cytogénétique, Génétique Moléculaire et Biologie de la Reproduction Humaines, CHU Farhat Hached Sousse et Université de Monastir, Monastir, Tunisie
| | - C Tous
- Service de Cytogénétique et Biologie de la Reproduction, CHRU Morvan, Brest, France
| | - N Gueganic
- Laboratoire d'histologie, Embryologie et Cytogénétique, INSERM U1078, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France
| | - F Brugnon
- CHU Clermont-Ferrand, AMP, CECOS, Clermont-Ferrand, France.,Faculté de Médecine, IMOST, INSERM 1240, Clermont-Ferrand, France
| | - H Ben Ali
- Laboratoire de Cytogénétique, Génétique Moléculaire et Biologie de la Reproduction Humaines, CHU Farhat Hached Sousse et Université de Monastir, Monastir, Tunisie
| | - L Bujan
- Groupe de Recherche en Fertilité Humaine, EA 3694, Groupe d'activité de Médecine de la Reproduction, Université Paul Sabatier et CECOS, CHU Toulouse, France
| | - N Moinard
- Groupe de Recherche en Fertilité Humaine, EA 3694, Groupe d'activité de Médecine de la Reproduction, Université Paul Sabatier et CECOS, CHU Toulouse, France
| | - E Caire-Tetauru
- Service de Cytogénétique et Biologie de la Reproduction, CHRU Morvan, Brest, France
| | - M Ajina
- Unité de Médecine de la Reproduction, CHU Farhat Hached, Sousse, Tunisie
| | - N Douet-Guilbert
- Laboratoire d'histologie, Embryologie et Cytogénétique, INSERM U1078, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France.,Service de Cytogénétique et Biologie de la Reproduction, CHRU Morvan, Brest, France
| | - F Morel
- Laboratoire d'histologie, Embryologie et Cytogénétique, INSERM U1078, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France.,Service de Cytogénétique et Biologie de la Reproduction, CHRU Morvan, Brest, France
| | - A Perrin
- Laboratoire d'histologie, Embryologie et Cytogénétique, INSERM U1078, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France.,Service de Cytogénétique et Biologie de la Reproduction, CHRU Morvan, Brest, France
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12
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Herrero MB, Lusignan MF, Son WY, Sabbah M, Buckett W, Chan P. ICSI outcomes using testicular spermatozoa in non-azoospermic couples with recurrent ICSI failure and no previous live births. Andrology 2019; 7:281-287. [PMID: 30734539 DOI: 10.1111/andr.12591] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of testicular over ejaculated spermatozoa for ICSI has been presented as an alternative to overcome infertility in men with poor semen parameters or high levels of sperm DNA fragmentation. OBJECTIVE To evaluate the efficacy of testicular ICSI outcomes in couples with no previous live birth and recurrent ICSI failure using ejaculated spermatozoa by comparison to the outcomes of couples with similar history of recurrent ICSI using ejaculated spermatozoa only. MATERIALS AND METHODS A total of 145 couples undergoing ejaculated or testicular ICSI cycles with no previous live births and with at least two previous failed ICSI cycles with ejaculated spermatozoa were evaluated retrospectively. ICSI was performed either with ejaculated (E-ICSI) or with testicular (T-ICSI) spermatozoa. Semen parameters and sperm DNA quality were assessed prior to the oocyte collection day. Primary outcomes included cumulative live birth and pregnancy rates. Secondary analysis included percentage of DNA fragmentation in ejaculated spermatozoa (SCSA® and TUNEL). RESULTS Patients undergoing T-ICSI (n = 77) had a significantly higher clinical pregnancy rate/fresh embryo transfer (ET) (27.9%; 17/61) and cumulative live birth rate (23.4%; 15/64) compared to patients using E-ICSI (n = 68) (clinical pregnancy rate/fresh ET: 10%; 6/60 and cumulative live birth rate: 11.4%; 7/61). Further, T-ICSI yield significantly better cumulative live birth rates than E-ICSI for men with high TUNEL (≥36%) (T-ICSI: 20%; 3/15 vs. E-ICSI: 0%; 0/7, p < 0.025), high SCSA® (≥25%) scores (T-ICSI: 21.7%; 5/23 vs. E-ICSI: 9.1%; 1/11, p < 0.01), or abnormal semen parameters (T-ICSI: 28%; 7/25 vs. E-ICSI: 6.7%; 1/15, p < 0.01). CONCLUSIONS The use of testicular spermatozoa for ICSI in non-azoospermic couples with no previous live births, recurrent ICSI failure, and high sperm DNA fragmentation yields significantly better live birth outcomes than a separate cohort of couples with similar history of ICSI failure entering a new ICSI cycle with ejaculated spermatozoa.
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Affiliation(s)
- M B Herrero
- MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada
| | - M F Lusignan
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - W-Y Son
- MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada
| | - M Sabbah
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - W Buckett
- MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada
| | - P Chan
- MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada.,The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada
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13
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Beaud H, Tremblay AR, Chan PTK, Delbes G. Sperm DNA Damage in Cancer Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:189-203. [PMID: 31301053 DOI: 10.1007/978-3-030-21664-1_11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fertility is a growing healthcare issue for a rising number of cancer survivors. In men, cancer itself and its treatment can negatively affect spermatogenesis by targeting the dividing spermatogonia and their cellular environment, ultimately leading to a reduction of testicular germ cells and sperm count. Experimental data and prospective longitudinal studies have shown that sperm production can recover after cancer treatment. But despite this, yet unpredictable, recovery in sperm production, cancer survivors are more at risk to produce sperm with aneuploidy, DNA damage, abnormal chromatin structure, and epigenetic defects even 2 years post-treatment. Sperm DNA alteration is of clinical concern, as these patients may father children or seek assisted reproduction technologies (ART) using gametes with damaged genome that could result in adverse progeny outcomes. Interestingly, large cohort studies revealed lower birth rate but no significant impact on the health of the children born from male cancer survivors (naturally or using ART). Nevertheless, a better understanding of how cocktail of chemotherapy and new anticancer agents affect spermatogenesis and sperm quality is needed to reduce side effects. Moreover, developing new fertility preservation strategies is essential as sperm cryopreservation before treatment is currently the only option but does not apply for prepubertal/young postpubertal patients.
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Affiliation(s)
- Hermance Beaud
- Institut national de la recherche scientifique, Centre INRS - Institut Armand-Frappier, QC, Canada
| | - Amelie R Tremblay
- Institut national de la recherche scientifique, Centre INRS - Institut Armand-Frappier, QC, Canada
| | - Peter T K Chan
- Division of Urology, McGill University Health Center, QC, Canada
| | - Geraldine Delbes
- Institut national de la recherche scientifique, Centre INRS - Institut Armand-Frappier, QC, Canada.
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14
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Lusignan MF, Li X, Herrero B, Delbes G, Chan PTK. Effects of different cryopreservation methods on DNA integrity and sperm chromatin quality in men. Andrology 2018; 6:829-835. [PMID: 30175448 DOI: 10.1111/andr.12529] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cryopreserved human sperm are used in assisted reproductive technology. However, the effect of cryopreservation on sperm DNA integrity is unclear. OBJECTIVES The objectives of this study were to: (i) determine the impact of semen cryopreservation on human sperm DNA integrity and chromatin structure; (ii) test if parameters obtained from TUNEL and SCSA® correlate; and (iii) verify correlation between sperm motility, morphology and viability with TUNEL and SCSA® parameters. MATERIALS AND METHODS Men attending a fertility clinic were recruited and grouped according to their sperm parameters (n = 9/group): normozoospermia, oligoasthenoteratozoospermia and teratozoospermia. Each semen sample was processed as follow: (i) directly frozen at -80 °C; (ii) diluted in Sperm Maintenance Medium, cooled for 30 min at 4 °C and frozen at -80 °C; (iii) diluted in Sperm Maintenance Medium; or (iv) in SpermFreeze. Each mixture from method (iii) and (iv) was then suspended for 30 min in liquid nitrogen vapor and plunged into liquid nitrogen. After at least two months of storage, samples were thawed at room temperature and analyzed for motility and viability, TUNEL and SCSA® assays. RESULTS Progressive motility and viability decreased after freeze-thawing. TUNEL scores increased significantly in all samples after freezing-thawing while no significant change in the DNA fragmentation index (DFI) from SCSA® was observed. No change in the percentage high DNA stainability (HDS) was observed in normozoospermic samples; however it was significantly increased in all the methods in oligoasthenoteratozoospermic and in the methods (ii)-(iv) in teratozoospermic samples. The DFI and TUNEL scores correlated significantly with each other and inversely with sperm motility, viability and morphology. DISCUSSION AND CONCLUSION Cryopreservation seems to be deleterious for the integrity of human sperm DNA and compaction. However, the sperm DFI was not affected during cryopreservation under the various methods of storage tested. Clinicians and investigators should take this information into consideration when using cryopreserved sperm for assisted reproduction.
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Affiliation(s)
- M F Lusignan
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - X Li
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - B Herrero
- MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada
| | - G Delbes
- INRS - Institut Armand Frappier, Laval, QC, Canada
| | - P T K Chan
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada.,MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada
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15
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Moradian Fard Z, Naghdi M, Salehi P, Ajami A, Deemeh MR, Meshkibaf MH. Can SCSA and TUNEL forecast apoptosis-related motility depletion in Asthenozoospermia? Andrologia 2018; 50:e13025. [DOI: 10.1111/and.13025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Z. Moradian Fard
- Department of Clinical Biochemistry; Fasa University of Medical Science; Fasa Iran
| | - M. Naghdi
- Department of Anatomy; Fasa University of Medical Science; Fasa Iran
| | - P. Salehi
- Infertility center; Shahid Beheshti Hospital; Isfahan Iran
| | - A. Ajami
- Andrology Section; Nobel Mega-laboratory; Isfahan Iran
| | - M. R. Deemeh
- Andrology Section; Nobel Mega-laboratory; Isfahan Iran
| | - M. H. Meshkibaf
- Department of Clinical Biochemistry; Fasa University of Medical Science; Fasa Iran
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Berteli TS, Da Broi MG, Martins WP, Ferriani RA, Navarro PA. Magnetic-activated cell sorting before density gradient centrifugation improves recovery of high-quality spermatozoa. Andrology 2017. [PMID: 28622434 DOI: 10.1111/andr.12372] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent studies have evaluated the use of magnetic-activated cell sorting (MACS) to reduce apoptotic spermatozoa and improve sperm quality. However, the efficiency of using MACS alone, before or after sperm processing by density gradient centrifugation (DGC) has not yet been established. The purpose of this study is to determine the optimal protocol of MACS in assisted reproduction techniques (ART). Thus, we compared sperm quality obtained by DGC alone (DGC), DGC followed by MACS (DGC-MACS), MACS followed by DGC (MACS-DGC), and MACS alone (MACS), and found that the combined methods (MACS-DGC and DGC-MACS) led to retrieval of less spermatozoa with fragmented DNA compared to the single protocols. However, MACS-DGC protocol led to a significantly higher percentage of spermatozoa with progressive motility and normal morphology than DGC-MACS protocol. These findings suggest the potential clinical value of using MACS-DGC to improve sperm quality in seminal preparation for ART.
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Affiliation(s)
- T S Berteli
- Human Reproduction Division, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - M G Da Broi
- Human Reproduction Division, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - W P Martins
- Human Reproduction Division, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - R A Ferriani
- Human Reproduction Division, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - P A Navarro
- Human Reproduction Division, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
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17
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Romany L, Garrido N, Cobo A, Aparicio-Ruiz B, Serra V, Meseguer M. Obstetric and perinatal outcome of babies born from sperm selected by MACS from a randomized controlled trial. J Assist Reprod Genet 2016; 34:201-207. [PMID: 27882439 DOI: 10.1007/s10815-016-0838-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/27/2016] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The purpose of this study is to assess outcomes after magnetic-activated cell sorting (MACS) technology on obstetric and perinatal outcomes compared with those achieved after swim up from randomized controlled trial. METHODS This is a two-arm, unicentric, prospective, randomized, and triple-blinded trial and has a total of 237 infertile couples, between October 2010 and January 2013. A total of 65 and 66 newborns from MACS and control group, respectively, were described. RESULTS MACS had no clinically relevant adverse effects on obstetric and perinatal outcomes. No differences were found for obstetric problems including premature rupture of membranes 6.1% (CI95% 0-12.8) vs. 5.9% (CI95% 0-12.4), 1st trimester bleeding 28.6% (CI95% 15.9-41.2) vs. 23.5% (CI95% 11.9-35.1), invasive procedures as amniocentesis 2.0% (CI95% 0-5.9) vs. 3.9% (CI95% 0-9.2), diabetes 14.3% (CI95% 4.5-24.1) vs. 9.8% (CI95% 1.6-17.9), anemia 6.1% (CI95% 0-12.8) vs. 5.9%(CI95% 0-12.4), 2nd and 3rd trimesters 10.2% (CI95% 1.7-18.7) vs. 5.9% (CI95% 0-12.4), urinary tract infection 8.2% (CI95% 0.5-15.9) vs. 3.9% (CI95% 0-9.2), pregnancy-induced hypertension 6.1% (CI95% 0-12.8) vs. 15.7% (CI95% 5.7-25.7), birth weight (g) 2684.10 (CI95% 2499.48-2868.72) vs. 2676.12 (CI95% 2499.02-2852.21), neonatal height (cm) 48.3 (CI95% 47.1-49.4) vs. 46.5 (CI95% 44.6-48.4), and gestational cholestasis 0%(CI95% 0-0) vs. 3.9% (CI95% 0-9.2), respectively, in MACS group compared with control group. CONCLUSIONS Our data suggest that MACS technology does not increase or decrease Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation adverse obstetric and perinatal outcomes in children conceived when this technology was performed, being the largest randomized control trial with live birth reported results with MACS.
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Affiliation(s)
- Laura Romany
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Nicolas Garrido
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Ana Cobo
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Belen Aparicio-Ruiz
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Vicente Serra
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Marcos Meseguer
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain. .,Instituto Valenciano de Infertilidad, Plaza de la Policía Local, 3, Valencia, 46015, Spain.
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18
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Witt KD, Beresford L, Bhattacharya S, Brian K, Coomarasamy A, Cutting R, Hooper R, Kirkman-Brown J, Khalaf Y, Lewis SE, Pacey A, Pavitt S, West R, Miller D, Cutting R. Hyaluronic Acid Binding Sperm Selection for assisted reproduction treatment (HABSelect): study protocol for a multicentre randomised controlled trial. BMJ Open 2016; 6:e012609. [PMID: 27855103 PMCID: PMC5073628 DOI: 10.1136/bmjopen-2016-012609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The selection of a sperm with good genomic integrity is an important consideration for improving intracytoplasmic sperm injection (ICSI) outcome. Current convention selects sperm by vigour and morphology, but preliminary evidence suggests selection based on hyaluronic acid binding may be beneficial. The aim of the Hyaluronic Acid Binding Sperm Selection (HABSelect) trial is to determine the efficacy of hyaluronic acid (HA)-selection of sperm versus conventionally selected sperm prior to ICSI on live birth rate (LBR). The mechanistic aim is to assess whether and how the chromatin state of HA-selected sperm corresponds with clinical outcomes-clinical pregnancy rate (CPR), LBR and pregnancy loss (PL). METHODS AND ANALYSIS Couples attending UK Centres will be approached, eligibility screening performed and informed consent sought. Randomisation will occur within 24 hours prior to ICSI treatment. Participants will be randomly allocated 1:1 to the intervention arm (physiological intracytoplasmic sperm injection, PICSI) versus the control arm using conventional methods (ICSI). The primary clinical outcome is LBR ≥37 weeks' gestation with the mechanistic study determining LBR's relationship with sperm DNA integrity. Secondary outcomes will determine this for CPR and PL. Only embryologists performing the procedure will be aware of the treatment allocation. Steps will be taken to militate against biases arising from embryologists being non-blinded. Randomisation will use a minimisation algorithm to balance for key prognostic variables. The trial is powered to detect a 5% difference (24-29%: p=0.05) in LBR ≥37 weeks' gestation. Selected residual sperm samples will be tested by one or more assays of DNA integrity. ETHICS AND DISSEMINATION HABSelect is a UK NIHR-EME funded study (reg no 11/14/34; IRAS REF. 13/YH/0162). The trial was designed in partnership with patient and public involvement to help maximise patient benefits. Trial findings will be reported as per CONSORT guidelines and will be made available in lay language via the trial web site (http://www.habselect.org.uk/). TRIAL REGISTRATION NUMBER ISRCTN99214271; Pre-results.
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Affiliation(s)
- K D Witt
- Department: Centre for Primary Care & Public Health, Queen Mary University of London, London, UK
| | - L Beresford
- Department: Centre for Primary Care & Public Health, Queen Mary University of London, London, UK
| | - S Bhattacharya
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - K Brian
- Charity Registration No. 1099960 (InfertilityNetworkUK), London, UK
| | - A Coomarasamy
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women's Fertility Centre, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Rachel Cutting
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | - R Hooper
- Department: Centre for Primary Care & Public Health, Queen Mary University of London, London, UK
| | - J Kirkman-Brown
- Centre for Human Reproductive Science, University of Birmingham, Birmingham Women's Fertility Centre, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Y Khalaf
- Assisted Conception Unit, Guy's and St Thomas's Hospital, London, UK
| | - S E Lewis
- Queen's University Belfast, Institute of Pathology, Belfast, UK
| | - A Pacey
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - S Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - R West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Miller
- Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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de la Torre J, Sánchez-Martín P, Gosálvez J, Crespo F. Equivalent seminal characteristics in human and stallion at first and second ejaculated fractions. Andrologia 2016; 49. [PMID: 27660115 DOI: 10.1111/and.12708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/28/2022] Open
Abstract
Sperm quality was assessed in normozoospermic human (n = 10) and Spanish breed stallion (n = 10) after sperm fractionation during ejaculation. The first ejaculated fraction was separated from the second. A third sample was reconstituted using equivalent proportion of both fractions (RAW). Fraction 1, Fraction 2 and RAW semen were incubated for 30 min at 37°C to homogenise the impact of iatrogenic damage between both species. Sperm concentration, motility and sperm DNA damage were assessed in each fraction and RAW semen. The results showed two important facts: (i) spermatozoa confined at Fraction 1 exhibit superior parameters than those included at Fraction 2 in both species, and (ii) there is a certain level of concordance between species in the proportion of benefit observed when Fraction 1 is compared to RAW semen. Altogether, these results call into question whether the standard practice of whole ejaculate collection can be considered the best strategy when using male gametes for artificial insemination. In fact, the reconstituted RAW semen exhibits poorer semen characteristics than those found in Fraction 1.
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Affiliation(s)
- J de la Torre
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - J Gosálvez
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | - F Crespo
- Departamento de Reproducción, Centro Militar de Cría Caballar (FESCCR, Ministerio de Defensa), Ávila, Spain
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Bucar S, Gonçalves A, Rocha E, Barros A, Sousa M, Sá R. DNA fragmentation in human sperm after magnetic-activated cell sorting. J Assist Reprod Genet 2014; 32:147-54. [PMID: 25374393 DOI: 10.1007/s10815-014-0370-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE As fertilization with unselected apoptotic spermatozoa may contribute to failures in assisted reproductive techniques, it has become essential to remove this type of sperm in order to increase the success rates. Magnetic-activated cell sorting (MACS) is a sperm preparation technique that isolates non-apoptotic spermatozoa based on the expression of phosphatidylserine in the membrane of apoptotic sperm. Therefore, we aimed to evaluate whether there was a significant decrease in sperm DNA fragmentation (sDNAfrag) and verify which protocol was the most efficient. METHODS Hundred semen samples were allocated into five distinct groups and processed according to a combination of MACS with density gradient centrifugation (DGC) and swim-up (SU) techniques. Sperm DNA fragmentation was evaluated by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. RESULTS Groups DGC-SU (73.4 %), DGC-MACS-SU (78.9 %), DGC-SU-MACS (53.8 %) and MACS-SU (73.5 %) presented a significant decrease in sDNAfrag but the highest reduction rate was obtained with MACS-DGC-SU (83.3 %). The later was also negatively correlated with sperm vitality, membrane integrity and progressive motility. Additionally, teratozoospermic patients presented a tendency to have lower sDNAfrag reduction rates than asthenozoospermic and asthenoteratozoospermic patients. CONCLUSIONS Based on the results, MACS showed potential to optimize the sDNAfrag reduction rate, when applied to raw semen, before DGC and SU, especially in samples with low values of progressive motility, vitality and hypoosmotic swelling test.
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Affiliation(s)
- Sara Bucar
- Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Multidisciplinary Unit for Biomedical Research (UMIB), Rua Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
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Herrero MB, Delbes G, Chung JT, Son WY, Holzer H, Buckett W, Chan P. Case report: the use of annexin V coupled with magnetic activated cell sorting in cryopreserved spermatozoa from a male cancer survivor: healthy twin newborns after two previous ICSI failures. J Assist Reprod Genet 2013; 30:1415-9. [PMID: 24057155 DOI: 10.1007/s10815-013-0086-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/13/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of the study is to report successful outcome (live births) after sperm sorting with annexin V-MACS on cryopreserved spermatozoa with high level of sperm DNA fragmentation from a cancer patient survivor. METHODS Cryopreserved spermatozoa were sorted with annexin V-MACS prior to ICSI. Sperm DNA fragmentation was evaluated by SCSA(®) and TUNEL. RESULTS The couple had two previous IVF/ICSI cycles failures using sperm cryopreserved before cancer treatment. On third ICSI cycle attempt results were as follow: pre-annexin V-MACS sperm quality: 10 × 10(6)/ml, 3.3 % progressive motility, 1 % normal forms, TUNEL: 72.5 % positive cells, SCSA(®): 76.6 % DFI. Post-annexin V-MACS sperm quality: 2.8 × 10(6)/ml, 10 % progressive motility, TUNEL: 58.8 % positive cells. Eight metaphase II oocytes were collected, 4 fertilized, 2 embryos were transferred on day 3 and healthy twins were born (1 boy, 1 girl). CONCLUSIONS Annexin V-MACS technique could be a potential tool to improve sperm quality on cryopreserved spermatozoa of cancer patient and improve ICSI outcome.
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Affiliation(s)
- María Belén Herrero
- MUHC Reproductive Center, McGill University Health Center, 687 Pine Av. West, Montreal, Quebec, Canada
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