Efficacy of Various Sperm Selection Strategies in Obtaining Sperm with Improved DNA Integrity: A Prospective Study

Increased sperm DNA fragmentation index (DFI) despite normal semen analysis may be encountered in couples with unexplained recurrent pregnancy loss. Therefore, implementing strategies for selecting sperm cells with appropriate DNA integrity may improve the outcomes of assisted reproductive technology (ART). This study compared the efficacy of short abstinence, magnetic activated cell sorting (MACS), and zeta potential in obtaining sperm cells of improved quality. Accordingly, among couples with recurrent ART failures or recurrent abortions, 30 men with increased sperm DFI (sperm chromatin dispersion [SCD] more than 18 %) were enrolled. Subsequently, each participant provided a semen specimen after abstaining for 2 to 3 days. This specimen was divided into three parts. Sample 1 underwent semen analysis and DNA integrity/protamination evaluation using SCD/chromomycin A3 (CMA3) indices. Samples 2 and 3 underwent similar assessments after processing with zeta potential and the MACS techniques, respectively. Finally, Sample 4 was provided the following day after a short abstinence of 24 hr, and was analyzed as the previous samples. Based on the results, Sample 1 had the highest sperm count, and MACS preserved more sperm compared with zeta potential. By applying the three mentioned strategies, the percentage of sperm cells with progressive movement increased significantly, with MACS being more effective compared with the zeta potential (p < .001). MACS and zeta potential methods provided more sperm with normal morphology and fewer sperm with abnormal SCD/CMA3 tests (p < .001). These three strategies may provide sperm exhibiting better DNA integrity, with the MACS being the superior approach.