Magnetic-activated cell sorting non-apoptotic sperm selection improves DNA fragmentation and reproductive outcomes:...

Medically assisted reproduction (MAR) relies on semen quality for success. While conventional sperm selection techniques such as density gradient centrifugation and swim-up are commonly used, they overlook essential molecular sperm characteristics, limiting their effectiveness in predicting the success of MAR. To address this, advanced selection techniques have been developed, including magnetic-activated cell sorting (MACS). This meta-analysis evaluates the effect of MACS compared with conventional sperm selection techniques on MAR reproductive outcomes, seminal parameters, and sperm DNA fragmentation (DNAf) levels. Systematic searches in PubMed, Web of Science and Scopus identified 41 studies that met the inclusion criteria. Results indicate that while MACS reduces sperm DNAf significantly (mean difference = -4.32, 95% CI -6.29 to -2.36; P < 0.0001), it does not significantly improve clinical pregnancy (OR = 1.47, 95% CI 0.94-2.30, P = 0.09), spontaneous miscarriage (OR = 0.92, 95% CI 0.40-2.12; P = 0.85) or live birth (OR = 1.55, 95% CI 0.78-3.11; P = 0.21) rates in artificial insemination cycles. However, in intracytoplasmic sperm injection cycles, MACS demonstrates significant improvements in implantation rate per transferred embryo (OR = 1.28, 95% CI 1.02-1.62; P = 0.04), clinical pregnancy (OR = 1.41, 95% CI 1.19-1.66; P < 0.00001) and live birth (OR = 1.31, 95% CI 1.09-1.58; P = 0.004) rates per embryo transfer, particularly in patients with high DNAf levels. Despite variability in other clinical parameters and study limitations such as data heterogeneity, the study results suggest a potential benefit of MACS in a specific subgroup of infertile patients, underscoring the need for personalized evaluation and further research to refine its clinical indications.