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Updated: Jun 3, 2026
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Sperm Collection of Differential Quality Using Density Gradient Centrifugation
Published on: November 29, 2018
Advanced sperm selection techniques for assisted reproduction
Akanksha Garg1,2, Olivia Nakhla3, Michelle Steeper3
1Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, USA.
The Cochrane Database of Systematic Reviews
|June 2, 2026
Summary
Advanced sperm selection techniques in assisted reproductive technologies (ART) show promise. Hyaluronic acid-selected ICSI (HA-ICSI) may slightly increase live births and reduce miscarriages, but more research is needed for other methods.
Area of Science:
- Reproductive Medicine andrology
- Assisted Reproductive Technologies (ART)
- Sperm Selection Techniques
Background:
- Assisted reproductive technologies (ART), including IVF and ICSI, aim to enhance fertilization and pregnancy rates.
- Advanced sperm selection techniques are increasingly used in ART, particularly with ICSI, to improve the selection of high-quality sperm.
- This review is an update of previous Cochrane reviews assessing the benefits and harms of these advanced techniques.
Purpose of the Study:
- To evaluate the benefits and harms of various advanced sperm selection techniques on assisted reproductive technologies (ART) outcomes.
- To synthesize evidence from randomized controlled trials (RCTs) comparing advanced sperm selection methods against standard procedures or other advanced techniques.
Main Methods:
- Systematic search of electronic databases (CENTRAL, MEDLINE, Embase) and handsearching of reference lists for relevant RCTs.
- Inclusion of RCTs comparing advanced sperm selection techniques versus standard IVF/ICSI or other advanced methods; exclusion of IMSI studies.
- Data extraction and risk of bias assessment (Cochrane RoB 2 tool) by two independent reviewers, with data synthesis using a fixed-effect model and GRADE certainty evaluation.
Main Results:
- Hyaluronic acid-selected ICSI (HA-ICSI) showed low-certainty evidence of no significant difference or a slight increase in live birth rates (24-31% vs 25%).
- HA-ICSI demonstrated moderate-certainty evidence of a probable slight decrease in miscarriage rates, both per woman (3-6% vs 7%) and per clinical pregnancy (8-15% vs 18%).
- Evidence for other advanced techniques (SpermSlow, zeta potential, microfluidic sorting) was very low certainty, leading to uncertainty regarding their effects on live birth, miscarriage, and clinical pregnancy.
Conclusions:
- HA-ICSI may offer a slight benefit in live birth rates and a probable reduction in miscarriage rates, though evidence certainty is low to moderate.
- The effects of other advanced sperm selection techniques remain largely unknown due to very low certainty evidence.
- Further high-quality studies, including data from ongoing trials, are necessary to determine the clinical recommendation of these advanced sperm selection methods.
