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Maghraby H, Elsuity MA, Adel N, Magdi Y, Abdelbadie AS, Rashwan MM, Ahmed OY, Elmahdy M, Khan KS, Fawzy M. Quantifying the association of sperm DNA fragmentation with assisted reproductive technology outcomes: An umbrella review. BJOG 2024; 131:1181-1196. [PMID: 38450853 DOI: 10.1111/1471-0528.17796] [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: 11/06/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Systematic reviews and meta-analyses are instrumental in shaping clinical practice. However, their findings can sometimes be marred by discrepancies and potential biases, thereby diluting the strength of the evidence presented. Umbrella reviews serve to comprehensively assess and synthesise these reviews, offering a clearer insight into the quality of the evidence presented. In the context of the relationship between sperm DNA fragmentation (SDF) and assisted conception outcomes, there is a divergence in the literature. Some reviews suggest a clear cause-and-effect linkage, whereas others present conflicting or inconclusive results. OBJECTIVES In this umbrella review we aimed to synthesise the evidence collated in systematic reviews and meta-analyses summarising the association of SDF with assisted reproductive technology (ART) outcomes. SEARCH STRATEGY After preregistration (https://doi.org/10.17605/OSF.IO/6JHDP), we performed a comprehensive search of the PubMed, Scopus, Cochrane Library, Web of Science and Embase databases. We conducted a search for systematic reviews on the association between SDF and ART without any restrictions on language or publication date. SELECTION CRITERIA Systematic reviews and meta-analyses assessing the association between SDF and ART outcomes were eligible. DATA COLLECTION AND ANALYSIS We assessed the quality of the included reviews using AMSTAR 2 and ROBIS, and determined the degree of overlap of primary studies between reviews estimating the corrected covered area (CCA), adjusted for structural missingness. We evaluated the most recent reviews assessing the association of SDF with live birth, pregnancy, miscarriage, implantation, blastulation and fertilisation. The synthesis of evidence was harmonised across all included quantitative syntheses, re-estimating the odds ratio (eOR) in random-effects meta-analyses with 95% confidence intervals (95% CIs) and 95% prediction intervals (95% PIs). We categorised the evidence strength into convincing, highly suggestive, suggestive, weak or nonsignificant, according to the meta-analysis re-estimated P-value, total sample size, I2 statistic for heterogeneity, small study effect, excess significance bias and the largest study significance. MAIN RESULTS We initially captured and screened 49 332 records. After excluding duplicate and ineligible articles, 22 systematic reviews, 15 of which were meta-analyses, were selected. The 22 reviews showed a moderate degree of overlap (adjusted CCA 9.2%) in their included studies (overall n = 428, with 180 unique studies). The 15 meta-analyses exhibited a high degree of overlap (adjusted CCA = 13.6%) in their included studies (overall n = 274, with 118 unique studies). AMSTAR 2 categorised the quality of evidence in 18 reviews as critically low and the quality of evidence in four reviews as low. ROBIS categorised all the reviews as having a high risk of bias. The re-estimated results showed that the association of SDF with live birth was weak in one and nonsignificant in four meta-analyses. Similarly, the association of SDF with pregnancy, miscarriage, implantation, blastulation and fertilisation was also weak or nonsignificant. The association of high SDF with different ART outcomes was also weak or nonsignificant for different interventions (IVF, ICSI and IUI) and tests. CONCLUSIONS This umbrella review did not find convincing or suggestive evidence linking SDF with ART outcomes. Caution should be exercised in making any claims, policies or recommendations concerning SDF.
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Affiliation(s)
- Hassan Maghraby
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Mohamad AlaaEldein Elsuity
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Dermatology, Venereology and Andrology Department, Sohag University, Sohag, Egypt
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
| | - Nehal Adel
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Madina Fertility Centre, Madina Women's Hospital, Alexandria, Egypt
| | - Yasmin Magdi
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Al-Yasmeen Fertility and Gynaecology Centre, Benha, Qalubyia, Egypt
| | - Amr S Abdelbadie
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Department of Obstetrics and Gynaecology, Aswan University, Aswan, Egypt
| | - Mosab M Rashwan
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
- Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ola Youssef Ahmed
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Mohamed Elmahdy
- Obstetrics and Gynaecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
| | - Khalid S Khan
- Centre for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), University of Granada, Granada, Spain
| | - Mohamed Fawzy
- Egyptian Foundation for Reproductive Medicine and Embryology (EFRE), Alexandria, Egypt
- Ibnsina, Ajyal, Qena, Amshag IVF Facilities, Sohag and Assiut, Egypt
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Du C, Tuo Y. Correlation of DNA fragments with routine semen parameters and lifestyle and their impact on assisted reproductive outcomes. Rev Int Androl 2022; 21:100337. [PMID: 36266233 DOI: 10.1016/j.androl.2022.03.001] [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: 11/17/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study investigated the correlation between sperm DNA integrity and routine semen evaluation parameters in male infertile patients, the influencing factors, and the impact of the DNA fragmentation index (DFI) on embryo quality and clinical outcomes in in vitro fertilization and embryo transfer (IVF-ET). METHODS Sperm DFI and semen routine parameters of 6160 infertile men admitted between June 2017 and June 2018 were analyzed. Patients were divided into three groups according to their DFI: low-DFI (DFI<15%), medium-DFI (15%<DFI≤30%), and high-DFI (DFI>30%). The correlations of DFI with patients' age, sperm concentration, sperm percentage of forward movement and sperm percentage of normal shape were analyzed. The clinical data of 5040 infertile couples who received IVF treatment between June 2016 and 2021 and had embryos transferred in a fresh cycle were reviewed. The fertilization rate, cleavage rate, blastocyst rate, and pregnancy rate in different DFI groups were compared. RESULTS Semen evaluation parameters (concentration, spermatozoa with progressive motility, and the normal morphology rate), the high-quality embryo rate, blastocyst development rate, and pregnancy rate in the high-DFI group were significantly lower than those in the other two groups. The correlation analysis revealed that sperm DFI was negatively correlated with semen concentration, sperm motility, and normal sperm morphology and positively correlated with the man's age, BMI, and unhealthy habits (smoking and drinking). There was no significant difference in the number of mature eggs and normal fertilization rate among groups. CONCLUSION A strong correlation exists between sperm DFI and semen evaluation parameters. Smoking, drinking, and other unhealthy habits lead to an increase in DFI, reducing the high-quality embryo rate and blastocyst development rate and affecting pregnancy outcomes.
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Affiliation(s)
- Chen Du
- Department of Reproductive Medicine Center, Affiliated Hospital, Inner Mongolia Medical University, Hohhot Inner Mongolia 010050, China
| | - Ya Tuo
- Department of Reproductive Medicine Center, Affiliated Hospital, Inner Mongolia Medical University, Hohhot Inner Mongolia 010050, China.
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Magnetic-Activated Cell Sorting as a Method to Improve Necrozoospermia-Related Asthenozoospermic Samples. J Clin Med 2022; 11:jcm11102914. [PMID: 35629040 PMCID: PMC9146750 DOI: 10.3390/jcm11102914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 02/05/2023] Open
Abstract
According to some statistics, absolute asthenozoospermia affects every 1 in 5000 men. Although this incidence rate does not appear to be too high, it is extremely important to address the phenomenon because it can drastically reduce the chances of pregnancy, even with assisted reproduction. The biggest problem with absolute asthenozoospermia is that it is difficult to distinguish between live and dead sperm cells, and fertilization with non-viable spermatozoa may contribute to the failure of an assisted reproduction cycle. Nowadays, DNA fragmentation (DF) is a crucial parameter of semen analysis, and in this paper, we provide evidence of the correlation between DF and vitality. For this purpose, the main semen parameters were investigated by a CASA system (concentration, motility, progressive motility, vitality and DF). In the necrozoospermic group (vitality < 58%), all the measured parameters showed significant differences compared to normal vitality. Concentration (30.1 M mL−1 vs. 13.6 M mL−1), motility (31.9% vs. 18.3%), and progressive motility (24.3% vs. 12.7%) were significantly decreased, while DF was significantly increased (17.4% vs. 23.7%). Based on the connection between vitality decrement and DF increment, DF lowering methods, such as magnetic-activated cell sorting, have been hypothesized as novel methods for the elimination of dead spermatozoa.
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Reproductive Outcomes of Different Sperm Selection Techniques for ICSI Patients with Abnormal Sperm DNA Fragmentation: a Randomized Controlled Trial. Reprod Sci 2021; 29:220-228. [PMID: 34076869 DOI: 10.1007/s43032-021-00642-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
The aim of the study is to compare the reproductive outcomes of different sperm selection techniques: density gradient centrifugation (DGC), testicular sperm (Testi), physiological ICSI (PICSI), and magnetic-activated cell sorting (MACS) in abnormal sperm DNA fragmentation (SDF) ICSI patients. A randomized controlled trial included 302 patients with abnormal SDF undergoing ICSI where they were randomized into 4 groups: a control group of DGC (n= 72), Testi (n=73), PICSI (n=78), and MACS (n=79). Results showed no significant differences in the male age, female age, or SDF between the four groups. Testi group had significantly lower cleavage and blastulation rates compared to PICSI, DGC, or MACS groups (p =0.001). For the high-quality blastocysts, DGC and MACS groups had significantly higher rate than the Testi group (p =0.014). The highest pregnancy rate was scored for the PICSI group (69.6%), while the lowest pregnancy rate was scored for the DGC group (51.4%) with (p =0.025). The PICSI group showed a significantly higher implantation rate compared to the other groups (p =0.003). Regarding the ongoing pregnancy rate, the significant difference was observed between the PICSI (62.8%) and MACS (62%) vs. DGC (45.8%). Besides, no significant differences were found in the miscarriage rates between the four groups. In conclusion, PICSI and MACS along with DGC showed significant improvement in embryological and clinical outcome over testicular sperm or sperm processed by DGC alone in patients with abnormal SDFRegistration number: NCT04482517.
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Pacheco A, Blanco A, Bronet F, Cruz M, García-Fernández J, García-Velasco JA. Magnetic-Activated Cell Sorting (MACS): A Useful Sperm-Selection Technique in Cases of High Levels of Sperm DNA Fragmentation. J Clin Med 2020; 9:jcm9123976. [PMID: 33302575 PMCID: PMC7763893 DOI: 10.3390/jcm9123976] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 01/19/2023] Open
Abstract
Magnetic-activated cell sorting (MACS) can be used to separate apoptotic sperm with high proportions of fragmented DNA from the rest, thus improving the overall quality of the seminal sample. Therefore, the aim of this retrospective study was to investigate the efficiency of the MACS technique to increase reproductive outcomes in patients with high levels of sperm DNA fragmentation (SDF) undergoing intracytoplasmic sperm-injection (ICSI) cycles. In this study, we analyzed a total of 724 assisted-reproduction-technique (ART) cycles that were divided into two groups: the study group (n = 366) in which the MACS selection technique was performed after density-gradient centrifugation (DGC), and the control group (n = 358) in which only DGC was used for sperm selection. Reproductive outcomes were analyzed in both groups according to three different ART procedures: preimplantation genetic testing for aneuploidy (PGT-A), and autologous and oocyte-donation cycles. The MACS group showed significantly lower miscarriage rates in autologous ICSI cycles, higher pregnancy rates in oocyte-donation cycles, and a significant increase in live-birth rates in both autologous and oocyte-donation cycles. Overall, these results suggested that the MACS technique can be effectively used to eliminate sperm with high SDF levels, and therefore may help to improve reproductive outcomes in couples undergoing ART.
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Affiliation(s)
- Alberto Pacheco
- IVI Madrid, 28023 Madrid, Spain; (F.B.); (M.C.); (J.A.G.-V.)
- Science Faculty, Alfonso X “El Sabio” University, Villanueva de la Cañada, 28691 Madrid, Spain
- Correspondence: ; Tel.: +34-911-802-900
| | | | - Fernando Bronet
- IVI Madrid, 28023 Madrid, Spain; (F.B.); (M.C.); (J.A.G.-V.)
| | - María Cruz
- IVI Madrid, 28023 Madrid, Spain; (F.B.); (M.C.); (J.A.G.-V.)
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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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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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Daneshmandpour Y, Pashazadeh F, Ansari F, Hosseinifard H, Nouri M, Yousefi M, Sakhinia E. The comparative effect of magnetic activated cell sorting, density gradient centrifugation and swim up on assisted reproduction outcomes, sperm DNA fragmentation, and aneuploidy: A systematic review and meta-analysis. Meta Gene 2019. [DOI: 10.1016/j.mgene.2019.100607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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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Live births from artificial insemination of microfluidic-sorted bovine spermatozoa characterized by trajectories correlated with fertility. Proc Natl Acad Sci U S A 2018; 115:E3087-E3096. [PMID: 29555773 PMCID: PMC5889641 DOI: 10.1073/pnas.1717974115] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Selection of functional spermatozoa plays a crucial role in assisted reproduction. Passage of spermatozoa through the female reproductive tract requires progressive motility to locate the oocyte. This preferential ability to reach the fertilization site confers fertility advantage to spermatozoa. Current routine sperm selection techniques are inadequate and fail to provide conclusive evidence on the sperm characteristics that may affect fertilization. We therefore developed a selection strategy for functional and progressively motile bovine spermatozoa with high DNA integrity based on the ability to cross laminar flow streamlines in a diffuser-type microfluidic sperm sorter (DMSS). The fluid dynamics, with respect to microchannel geometry and design, are relevant in the propulsion of spermatozoa and, consequently, ultrahigh-throughput sorting. Sorted spermatozoa were assessed for kinematic parameters, acrosome reaction, mitochondrial membrane potential, and DNA integrity. Kinematic and trajectory patterns were used to identify fertility-related subpopulations: the rapid, straighter, progressive, nonsinuous pattern (PN) and the transitional, sinuous pattern (TS). In contrast to the conventional notion that the fertilizing spermatozoon is always vigorously motile and more linear, our results demonstrate that sinuous patterns are associated with fertility and correspond to truly functional spermatozoa as supported by more live births produced from predominant TS than PN subpopulation in the inseminate. Our findings ascertain the true practical application significance of microfluidic sorting of functional sperm characterized by sinuous trajectories that can serve as a behavioral sperm phenotype marker for fertility potential. More broadly, we foresee the clinical application of this sorting technology to assisted reproduction in humans.
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Chi HJ, Kim SG, Kim YY, Park JY, Yoo CS, Park IH, Sun HG, Kim JW, Lee KH, Park HD. ICSI significantly improved the pregnancy rate of patients with a high sperm DNA fragmentation index. Clin Exp Reprod Med 2017; 44:132-140. [PMID: 29026719 PMCID: PMC5636925 DOI: 10.5653/cerm.2017.44.3.132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 06/16/2017] [Accepted: 06/05/2017] [Indexed: 12/19/2022] Open
Abstract
Objective Correlations between semen parameters and sperm DNA fragmentation index (DFI) were investigated to identify characteristics of sperm without DNA damage that could be used in selecting sperm for intracytoplasmic sperm injection (ICSI). Pregnancy outcomes were compared to determine whether in vitro fertilization (IVF) or ICSI is a better choice for patients who have sperm with a high-DFI. Methods Semen analysis was carried out in 388 patients who visited our IVF center for the first time to investigate correlations between sperm DFI and semen parameters. In addition, 1,102 IVF cycles in 867 patients were carried out in the present study; 921 cycles in the low-DFI group (DFI <30%) and 181 cycles in the high-DFI group (DFI ≥30%). Both the low- and high-DFI groups were subdivided into IVF and ICSI cycle groups. Results Sperm DFI showed significant inverse correlations with sperm motility (r=−0.435, p<0.001) and morphology (r=−0.153, p<0.05). Sperm DFI also showed significant correlations with rapid motility (r=−0.436, p<0.001), and the kinetic parameters of average-path velocity (r=−0.403) and linearity (r=−0.412). Although there was no significant difference in the pregnancy rates between IVF (48.6%) and ICSI (44.8%) in the low-DFI group, the pregnancy rate of ICSI cycles (44.8%, p<0.05) was significantly higher than IVF cycles (25.0%) in the high-DFI group. No significant difference was observed in the abortion rates between the low-DFI (52 of 921, 5.6%) and high-DFI groups (7 of 181, 3.8%). Conclusion ICSI is a better choice than IVF for improving the pregnancy outcomes of patients who have sperm with a high DFI.
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Affiliation(s)
- Hee-Jun Chi
- IVF Center, Mamapapa and Baby Clinic, Ulsan, Korea
| | - Seok-Gi Kim
- IVF Center, Mamapapa and Baby Clinic, Ulsan, Korea.,Department of Biotechnology, Daegu University, Daegu, Korea
| | | | | | | | - Il-Hae Park
- IVF Center, Mamapapa and Baby Clinic, Ulsan, Korea
| | - Hong-Gil Sun
- IVF Center, Mamapapa and Baby Clinic, Ulsan, Korea
| | - Jae-Won Kim
- IVF Center, Mamapapa and Baby Clinic, Ulsan, Korea
| | | | - Hum-Dai Park
- Department of Biotechnology, Daegu University, Daegu, Korea
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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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