Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Comparison of the Efficiency of Magnetic-Activated Cell Sorting (MACS) and Physiological Intracytoplasmic Sperm Injection (PICSI) for Sperm Selection in Cases with Unexplained Infertility

Authors
Alireza Ahmadi 1
Aligholi Sobhani 2
Mohammad Ali Khalili 2
Azam Agha-Rahimi 2
Ali Nabi 3
Necati Findikli 4
1 Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4 Bahceci Fulya Assisted Reproduction Center, Istanbul, Iran; Department of Bioengineering, Beykent University, Istanbul, Iran
10.18502/jri.v23i3.10009
Abstract
Background: The cases with unexplained infertility may have an abnormality in their sperm chromatin structure. Sperm selection methods can be used to separate sperm with low DNA fragmentation. The purpose of this study was to compare the efficacy of physiological intracytoplasmic sperm injection (PICSI) with magnetic-activated cell sorting (MACS) in assisted reproductive techniques in cases with unexplained infertility. Methods: The semen samples were collected from couples with unexplained infertility. After semen analysis and sperm DNA fragmentation (SDF) evaluations, samples were prepared with swim-up method. The rates of SDF in different fractions including raw semen (n=20), swim-up (n=20), only motile sperm after swim-up (swim-up selection) (n=20), MACS sperm selection (n=20), only motile sperm after MACS (MACS selection) (n=20), and PICSI sperm selection (n=16) were evaluated. Also, the main sperm characteristics and fine morphology of sperm suspension after MACS were assessed. Statistical analysis was performed using GraphPad Prism. The p<0.05 was considered statistically significant. Results: DNA fragmentation index (DFI) values in PICSI and MACS groups were significantly reduced as compared to the swim-up group. The rate of this reduction was more pronounced in MACS (58.20±13.02) than PICSI (36.57±15.52) group. Also, our results showed that MACS resulted in decreased sperm motility, with no alteration in their fine morphology. Conclusion: MACS was found to be more efficient in reduction of SDF rates than PICSI. However, none of the sperm selection techniques can not totally eliminated the spermatozoa with DNA fragmentation in the final sperm sample.
Keywords
MACS
PICSI
SDF
Spermatozoa
Pierik FH, Van Ginneken AM, Dohle GR, Vreeburg JT, Weber RF. The advantages of standardized evaluation of male infertility. Int J Androl. 2000;23(6):340-6.
Santos R, Palos-Ladeiro M, Besnard A, Reggio J, Vulliet E, Porcher JM, et al. Parental exposure to methyl methane sulfonate of three-spined stickleback: contribution of DNA damage in male and female germ cells to further development impairment in progeny. Ecotoxicology. 2013;22(5):815-24.
Hamada A, Esteves SC, Nizza M, Agarwal A. Unexplained male infertility: diagnosis and management. Int Braz J Urol. 2012;38(5):576-94.
Bibancos M, Vaz RM, Mega PF, Borges E Jr, Ribeiro M, Buttros D, et al. Sperm selection for micro TESE-ICSI in Non-Obstructive azoospermia, a case report. JBRA Assist Reprod. 2021;25(4):653-6.
Duarte C, Núñez V, Wong Y, Vivar C, Benites E, Rodriguez U, et al. Impact of the Z potential technique on reducing the sperm DNA fragmentation index, fertilization rate and embryo development. JBRA Assist Reprod. 2017;21(4):351-5.
Alberts B, Johnson A, Lewis J, Morgan D, Raff M, Roberts K, et al. Molecular biology of the cell: USA: W.W. Norton & Company; 2014. 1464 p.
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):479-85.
Chung MK, Chiu PC, Lee CL, Pang RT, Ng EH, Lee KF, et al. Cumulus-associated alpha2-macroglobulin derivative retains proconceptive glycodelin-C in the human cumulus matrix. Hum Reprod. 2009;24(11):2856-67.
Kızılay F, Altay B. Sperm function tests in clinical practice. Turk J Urol. 2017;43(4):393-400.
Jakab A, Sakkas D, Delpiano E, Cayli S, Kovanci E, Ward D, et al. Intracytoplasmic sperm injection: a novel selection method for sperm with normal frequency of chromosomal aneuploidies. Fertil Steril. 2005;84(6):1665-73.
Cayli S, Sakkas D, Vigue L, Demir R, Huszar G. Cellular maturity and apoptosis in human sperm: creatine kinase, caspase-3 and Bcl-XL levels in mature and diminished maturity sperm. Mol Hum Reprod. 2004;10(5):365-72.
Omidi M, Faramarzi A, Agharahimi A, Khalili MA. Noninvasive imaging systems for gametes and embryo selection in IVF programs: a review. J Microsc. 2017;267(3):253-64.
Mangoli E, Khalili MA, Talebi AR, Kalantar SM, Montazeri F, Agharahimi A, et al. Association between early embryo morphokinetics plus transcript levels of sperm apoptotic genes and clinical outcomes in IMSI and ICSI cycles of male factor patients. J Assist Reprod Genet. 2020;37(10):2555-67.
Mangoli E, Khalili MA, Talebi AR, Agha‐Rahimi A, Soleimani M, Faramarzi A, et al. IMSI procedure improves clinical outcomes and embryo morphokinetics in patients with different aetiologies of male infertility. Andrologia. 2019;51(8):e13340.
Hasanen E, Elqusi K, ElTanbouly S, AlKhadr H, Zaki H, Henkel R, et al. PICSI vs. MACS for abnormal sperm DNA fragmentation ICSI cases: a prospective randomized trial. J Assist Reprod Genet. 2020;37(10):2605-13.
WHO. WHO laboratory manual for the examin-ation and processing of human semen. 5th ed. Geneva: World Health Organization; 2010. 271 p.
Cassuto NG, Bouret D, Plouchart JM, Jellad S, Vanderzwalmen P, Balet R, et al. A new real-time morphology classification for human spermatozoa: a link for fertilization and improved embryo quality. Fertil Steril. 2009;92(5):1616-25.
Anbari F, Khalili MA, Agha-Rahimi A, Maleki B, Nabi A, Esfandiari N. Does sperm DNA fragmentation have negative impact on embryo morphology and morphokinetics in IVF programme? Andrologia. 2020;52(11):e13798.
Neri QV, Tanaka N, Wang A, Katagiri Y, Takeuchi T, Rosenwaks Z, et al. Intracytoplasmic sperm injection. Minerva Ginecol. 2004;56:189-96.
World Health Organization. World health statistics 2010. 1st ed. Geneva: World Health Organization; 2010. 168 p.
Esbert M, Pacheco A, Soares S, Amorós D, Florensa M, Ballesteros A, et al. High sperm DNA fragmentation delays human embryo kinetics when oocytes from young and healthy donors are microinjected. Andrology. 2018;6(5):697-706.
Borges Jr E, Zanetti BF, Setti AS, Braga DPdAF, Provenza RR, Iaconelli Jr A. Sperm DNA fragmentation is correlated with poor embryo development, lower implantation rate, and higher miscarriage rate in reproductive cycles of non–male factor infertility. Fertil Steril. 2019;112(3):483-90.
Kim SM, Kim SK, Jee BC, Kim SH. Effect of sperm DNA fragmentation on embryo quality in normal responder women in in vitro fertilization and intracytoplasmic sperm injection. Yonsei Med J. 2019;60(5):461-6.
Yang H, Li G, Jin H, Guo Y, Sun Y. The effect of sperm DNA fragmentation index on assisted reproductive technology outcomes and its relationship with semen parameters and lifestyle. Transl Androl Urol. 2019;8(4):356-65.
Ten J, Guerrero J, Linares Á, Rodríguez-Arnedo A, Morales R, Lledó B, et al. Sperm DNA fragmentation on the day of fertilisation is not associated with assisted reproductive technique outcome independently of gamete quality. Hum Fertil (Camb). 2021:1-17.
Ribas‐Maynou J, Yeste M, Becerra‐Tomás N, Aston KI, James ER, Salas‐Huetos A. Clinical implications of sperm DNA damage in IVF and ICSI: updated systematic review and meta‐analysis. Biol Rev Camb Philos. 2021;96(4):1284-300.
Feijó CM, Esteves SC. Diagnostic accuracy of sperm chromatin dispersion test to evaluate sperm deoxyribonucleic acid damage in men with unexplained infertility. Fertil Steril. 2014;101(1):58-63.e3.
McDowell S, Kroon B, Ford E, Hook Y, Glujovsky D, Yazdani A. Advanced sperm selection techniques for assisted reproduction. Cochrane Database Syst Rev. 2014;(10):CD010461.
Xue X, Wang WS, Shi JZ, Zhang SL, Zhao WQ, Shi WH, et al. Efficacy of swim-up versus density gradient centrifugation in improving sperm deformity rate and DNA fragmentation index in semen samples from teratozoospermic patients. J Assist Reprod Genet. 2014;31(9):1161-6.
Parmegiani L, Cognigni GE, Bernardi S, Troilo E, Ciampaglia W, Filicori M. "Physiologic ICSI": hyaluronic acid (HA) favors selection of spermatozoa without DNA fragmentation and with normal nucleus, resulting in improvement of embryo quality. Fertil Steril. 2010;93(2):598-604.
Miller D, Pavitt S, Sharma V, Forbes G, Hooper R, Bhattacharya S, et al. Physiological, hyaluronan-selected intracytoplasmic sperm injection for infertility treatment (HABSelect): a parallel, two-group, randomised trial. Lancet. 2019;393(10170):416-22.
Lee TH, Liu CH, Shih YT, Tsao HM, Huang CC, Chen HH, et al. Magnetic-activated cell sorting for sperm preparation reduces spermatozoa with apoptotic markers and improves the acrosome reaction in couples with unexplained infertility. Hum Reprod. 2010;25(4):839-46.
Bucar S, Gonçalves A, Rocha E, Barros A, Sousa M, Sá R. DNA fragmentation in human sperm after magnetic-activated cell sorting. J Assist Reprod Genet. 2015;32(1):147-54.
Cakar Z, Cetinkaya B, Aras D, Koca B, Ozkavukcu S, Kaplanoglu İ, et al. Does combining magnetic-activated cell sorting with density gradient or swim-up improve sperm selection? J Assist Reprod Genet. 2016;33(8):1059-65.
Horta F, Crosby J, Mackenna A, Huidobro C. Male factor infertility outcomes using magnetic activated cell sorting in intra citoplasmatic sperm injection cycles. Andrology (Los Angel). 2016;5(1):1-6.
Dirican EK, Ozgün OD, Akarsu S, Akin KO, Ercan O, Uğurlu M, et al. Clinical outcome of magnetic activated cell sorting of non-apoptotic spermatozoa before density gradient centrifugation for assisted reproduction. J Assist Reprod Genet. 2008;25(8):375-81.
Delbes G, Herrero MB, Troeung ET, Chan PT. The use of complimentary assays to evaluate the enrichment of human sperm quality in asthenoteratozoospermic and teratozoospermic samples processed with Annexin-V magnetic activated cell sorting. Andrology. 2013;1(5):698-706.
Esteves SC, Agarwal A, Majzoub A. Comparison of strategies to reduce sperm DNA fragmentation in couples undergoing ICSI. Transl Androl Urol. 2017;6(Suppl 4):S570-3.
Lepine S, McDowell S, Searle LM, Kroon B, Glujovsky D, Yazdani A. Advanced sperm selection techniques for assisted reproduction. Cochrane Database Syst Rev. 2019:7(7): CD010461.
Journal of Reproduction & Infertility
Volume 23, Issue 3
Summer 2022
Pages 184-191