Reproductive Outcomes of Different Sperm Selection Techniques for ICSI Patients with Abnormal Sperm DNA...

Area of Science:

• Reproductive Medicine
• Andrology
• Embryology

Background:

• Abnormal sperm DNA fragmentation (SDF) negatively impacts ICSI outcomes.
• Selecting the optimal sperm preparation technique is crucial for improving success rates in assisted reproductive technologies.

Purpose of the Study:

• To compare the efficacy of four sperm selection techniques: density gradient centrifugation (DGC), testicular sperm (Testi), physiological ICSI (PICSI), and magnetic-activated cell sorting (MACS).
• To evaluate their impact on reproductive outcomes in patients with abnormal SDF undergoing ICSI.

Main Methods:

• A randomized controlled trial involving 302 patients with abnormal SDF undergoing ICSI.
• Patients were allocated to four groups: DGC (control), Testi, PICSI, and MACS.
• Reproductive outcomes including cleavage rates, blastulation rates, high-quality blastocysts, pregnancy rates, implantation rates, ongoing pregnancy rates, and miscarriage rates were assessed.

Main Results:

• No significant differences in male/female age or SDF levels were observed between groups.
• Testicular sperm (Testi) yielded significantly lower cleavage and blastulation rates (p=0.001).
• PICSI demonstrated the highest pregnancy rate (69.6%) and implantation rate (p=0.003).
• PICSI and MACS showed significantly higher ongoing pregnancy rates compared to DGC (p=0.025).
• DGC and MACS yielded higher rates of high-quality blastocysts than Testi (p=0.014).

Conclusions:

• PICSI and MACS, alongside DGC, significantly improve embryological and clinical outcomes in ICSI patients with abnormal SDF compared to testicular sperm or DGC alone.
• PICSI appears to be the most effective technique for improving pregnancy and implantation rates in this patient population.
• Further research may explore optimizing sperm selection protocols for specific male infertility factors.