MACS-DGC versus DGC Sperm Wash Procedure: Comparing Clinical Outcomes in Couples with Male Factor Infertility Undergoing ICSI: A Clinical Trial Study

Document Type : Original Article

Authors

1 Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran

2 Isfahan Fertility and Infertility Center, Isfahan, Iran

3 Memphasys Ltd, Sydney, Australia

Abstract

Background: Implementation of sperm preparation techniques based on cellular and molecular characteristics can improve the clinical outcomes of couples with male factor infertility. These methods attempt to select better sperm compared to classical methods of preparation such as swim-up and density gradient centrifugation (DGC). In this view, the aim of this study was the comparison of clinical outcomes of magnetic-activated cell separation (MACS) followed by DGC or DGC alone in infertile men undergoing intracytoplasmic sperm injection (ICSI).
Materials and Methods: For this prospective single parallel blind clinical trial study, 206 infertile couples with male factor infertility and having abnormal sperm morphology higher than 96% were included. 106 and 100 couples were considered for the study (MACS-DGC) and control group (DGC), respectively. Clinical outcomes of ICSI; fertilization, embryo quality, and implantation, pregnancy rates were compared between two groups.
Results: Mean of fertilization (80.19 ± 1.88 vs. 75.63 ± 2.06, P=0.1), top embryo quality on the day 3 (30.22 ± 3.59 vs. 17.96 ± 2.9, P=0.009), clinical pregnancy (30.76% vs. 22.22%, P=0.19), and implantation rate (18.12% vs. 10.42%, P=0.04) were higher in the study group compared to the control group.
Conclusion: Sperm preparation by MACS followed by DGC in teratozoospermic men could improve the clinical outcomes after ICSI (Registration number: IRCT201610317223N8).

Keywords

References

  1. Haddad M, Stewart J, Xie P, Cheung S, Trout A, Keating D, et al. Thoughts on the popularity of ICSI. J Assist Reprod Genet. 2021; 38(1): 101-123.
  2. Vaughan DA, Sakkas D. Sperm selection methods in the 21st century. Biol Reprod. 2019; 101(6): 1076-1082.
  3. Marzano G, Chiriacò MS, Primiceri E, Dell'Aquila ME, Ramalho-Santos J, Zara V, et al. Sperm selection in assisted reproduction: a review of established methods and cutting-edge possibilities. Biotechnol Adv. 2020; 40: 107498.
  4. Ammar O, Mehdi M, Muratori M. Teratozoospermia: its association with sperm DNA defects, apoptotic alterations, and oxidative stress. Andrology. 2020; 8(5): 1095-1106.
  5. Nagata S, Segawa K. Sensing and clearance of apoptotic cells. Curr Opin Immunol. 2021; 68: 1-8.
  6. Lestari SW, Lestari SH, Margiana R. An update of sperm preparation: a review of supplementation substances to improve sperm quality. Biomed Pharmacol J. 2018; 11(1).
  7. Oseguera-López I, Ruiz-Díaz S, Ramos-Ibeas P, Pérez-Cerezales S. Novel techniques of sperm selection for improving IVF and ICSI outcomes. Front Cell Dev Biol. 2019; 7: 298.
  8. Simopoulou M, Gkoles L, Bakas P, Giannelou P, Kalampokas T, Pantos K, et al. Improving ICSI: a review from the spermatozoon perspective. Syst Biol Reprod Med. 2016; 62(6): 359-371.
  9. Sánchez-Martín P, Dorado-Silva M, Sánchez-Martín F, González Martínez M, Johnston SD, Gosálvez J. Magnetic cell sorting of semen containing spermatozoa with high DNA fragmentation in ICSI cycles decreases miscarriage rate. Reprod Biomed Online. 2017; 34(5): 506-512.
  10. Grunewald S, Reinhardt M, Blumenauer V, Said TM, Agarwal A, Abu Hmeidan F, et al. Increased sperm chromatin decondensation in selected nonapoptotic spermatozoa of patients with male infertility. Fertil Steril. 2009; 92(2): 572-577.
  11. Gil M, Sar-Shalom V, Melendez Sivira Y, Carreras R, Checa MA. Sperm selection using magnetic activated cell sorting (MACS) in assisted reproduction: a systematic review and meta-analysis. J Assist Reprod Genet. 2013; 30(4): 479-485.
  12. Stimpfel M, Verdenik I, Zorn B, Virant-Klun I. Magnetic-activated cell sorting of non-apoptotic spermatozoa improves the quality of embryos according to female age: a prospective sibling oocyte study. J Assist Reprod Genet. 2018; 35(9): 1665-1674.
  13. Hozyen M, Hasanen E, Elqusi K, ElTanbouly S, Gamal S, Hussin AG, et al. Reproductive outcomes of different sperm selection techNorozi niques for ICSI patients with abnormal sperm DNA fragmentation: a randomized controlled trial. Reprod Sci. 2022; 29(1): 220-228.
  14. Ziarati N, Tavalaee M, Bahadorani M, Nasr Esfahani MH. Clinical outcomes of magnetic activated sperm sorting in infertile men can­didate for ICSI. Hum Fertil (Camb). 2019; 22(2): 118-125.
  15. Martin G, Sabido O, Durand P, Levy R. Phosphatidylserine ex­ternalization in human sperm induced by calcium ionophore A23187: relationship with apoptosis, membrane scrambling and the acrosome reaction. Hum Reprod. 2005; 20(12): 3459- 3468.
  16. Shin HW, Takatsu H. Phosphatidylserine exposure in living cells. Crit Rev Biochem Mol Biol. 2020; 55(2): 166-178.
  17. Tavalaee M, Deemeh MR, Arbabian M, Nasr-Esfahani MH. Density gradient centrifugation before or after magnetic-activated cell sort­ing: which technique is more useful for clinical sperm selection? J Assist Reprod Genet. 2012; 29(1): 31-38.
  18. World Health Organization. WHO laboratory manual for the exami­nation and processing of human semen. 5th ed. Cambridge: Cam­bridge University Press; 2010; 271.
  19. Zahedi A , Tavalaee M , Deemeh MR , Azadi L, Fazilati M , Nasr- Esfahani MH. Zeta potential vs apoptotic marker: which is more suitable for ICSI sperm selection? J Assist Reprod Genet. 2013; 30(9): 1181-1186.
  20. Giorgetti C, Terriou P, Auquier P, Hans E, Spach JL, Salzmann J, et al. Embryo score to predict implantation after in-vitro fertilization: based on 957 single embryo transfers. Hum Reprod. 1995; 10(9): 2427-2431.
  21. Terriou P, Giorgetti C, Hans E, Salzmann J, Charles O, Cignetti L, et al. Relationship between even early cleavage and day 2 embryo score and assessment of their predictive value for pregnancy. Re­prod Biomed Online. 2007; 14(3): 294-299.
  22. Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mou­zon J, Sokol R, et al. The international glossary on infertility and fertility care, 2017. Hum Reprod. 2017; 32(9): 1786-1801.
  23. Avendaño C, Franchi A, Taylor S, Morshedi M, Bocca S, Oehninger S. Fragmentation of DNA in morphologically normal human sper­matozoa. Fertil Steril. 2009; 91(4): 1077-1084.
  24. Avendaño C, Franchi A, Duran H, Oehninger S. DNA fragmentation of normal spermatozoa negatively impacts embryo quality and in­tracytoplas mic sperm injection outcome. Fertil Steril. 2010; 94(2): 549-557.
  25. Aitken RJ, Baker MA, Nixon B. Are sperm capacitation and apop­tosis the opposite ends of a continuum driven by oxidative stress? Asian J Androl. 2015; 17(4): 633-639.
  26. González-Marín C, Gosálvez J, Roy R. Types, causes, detection and repair of DNA fragmentation in animal and human sperm cells. Int J Mol Sci. 2012; 13(11): 14026-14052.
  27. García-Rodríguez A, Gosálvez J, Agarwal A, Roy R, Johnston S. DNA damage and repair in human reproductive cells. Int J Mol Sci. 2018; 20(1): 31.
  28. Dada R. Sperm DNA damage diagnostics: when and why. Transl Androl Urol. 2017; 6 Suppl 4: S691-S694.
  29. Kim BK, Park SK. Phosphatidylserine modulates response to oxi­dative stress through hormesis and increases lifespan via DAF-16 in Caenorhabditis elegans. Biogerontology. 2020; 21(2): 231-244.
  30. Renes J. Phosphatidylserine, another player in macrophage re­cruitment in white adipose tissue? Adipobiology, 2010; 2: 23-32.
  31. Rival CM, Xu W, Shankman LS, Morioka S, Arandjelovic S, Lee CS, et al. Phosphatidylserine on viable sperm and phagocytic ma­chinery in oocytes regulate mammalian fertilization. Nat Commun. 2019; 10(1): 4456.
  32. Salicioni AM, Platt MD, Wertheimer EV, Arcelay E, Allaire A, Sosnik J, et al. Signalling pathways involved in sperm capacitation. Soc Reprod Fertil Suppl. 2007; 65: 245-259.
  33. 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(12): 3976.
  34. Cakar Z, Cetinkaya B, Aras D, Koca B, Ozkavukcu S, Kaplanoglu I, et al. Does combining magnetic-activated cell sorting with den­sity gradient or swim-up improve sperm selection? J Assist Reprod Genet. 2016; 33(8): 1059-1065.
  35. Hasanen E, Elqusi K, ElTanbouly S, Hussin AE, AlKhadr H, Zaki H, et al. PICSI vs. MACS for abnormal sperm DNA fragmentation ICSI cases: a prospective randomized trial. J Assist Reprod Genet. 2020; 37(10): 2605-2613.
  36. Sixth edition. WHO laboratory manual for the examination and pro­cessing of human semen. 27 July 2021. Avialabale from: https:// www.who.int/publications/i/item/9789240030787 (15 Jun 2021).

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