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What Does Intracytoplasmic Sperm Injection Change in Embryonic Development? The Spermatozoon Contribution. J Clin Med 2023; 12:jcm12020671. [PMID: 36675600 PMCID: PMC9867417 DOI: 10.3390/jcm12020671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
The intracytoplasmic sperm injection (ICSI) technique was invented to solve severe male infertility due to altered sperm parameters. Nowadays, it is applied worldwide for the treatment of couple infertility. ICSI is performed with any available spermatozoon from surgery or ejaculated samples, whatever are the sperm motility, morphology or quantity. The aim of the present review was to study if embryo development and kinetics would be modified by (1) ICSI under the technical aspects, (2) the micro-injected spermatozoa in connection with male infertility. From published data, it can be seen that ICSI anticipates the zygote kinetics Furthermore, because fertilization rate is higher in ICSI compared to conventional in vitro fertilization (IVF), more blastocysts are obtained for clinical use in ICSI. Sperm and spermatozoa characteristics, such as sperm parameters, morphology and vitality, DNA content (levels of sperm DNA fragmentation, microdeletions, and chromosomal abnormalities), RNA content, epigenetics, and sperm recovery site (testicular, epididymis, and ejaculated), have an impact on fertilization and blastocyst rates and embryo kinetics in different ways. Even though ICSI is the most common solution to solve couples' infertility, the causes of male infertility are crucial in building a competent spermatozoa that will contribute to normal embryonic development and healthy offspring.
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Ribas-Maynou J, Barranco I, Sorolla-Segura M, Llavanera M, Delgado-Bermúdez A, Yeste M. Advanced Sperm Selection Strategies as a Treatment for Infertile Couples: A Systematic Review. Int J Mol Sci 2022; 23:ijms232213859. [PMID: 36430331 PMCID: PMC9695162 DOI: 10.3390/ijms232213859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Assisted reproductive technology (ART) is an essential tool to overcome infertility, and is a worldwide disease that affects millions of couples at reproductive age. Sperm selection is a crucial step in ART treatment, as it ensures the use of the highest quality sperm for fertilization, thus increasing the chances of a positive outcome. In recent years, advanced sperm selection strategies for ART have been developed with the aim of mimicking the physiological sperm selection that occurs in the female genital tract. This systematic review sought to evaluate whether advanced sperm selection techniques could improve ART outcomes and sperm quality/functionality parameters compared to traditional sperm selection methods (swim-up or density gradients) in infertile couples. According to preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines), the inclusion and exclusion criteria were defined in a PICOS (population, intervention, comparator, outcome, study) table. A systematic search of the available literature published in MEDLINE-PubMed until December 2021 was subsequently conducted. Although 4237 articles were recorded after an initial search, only 47 studies were finally included. Most reports (30/47; 63.8%) revealed an improvement in ART outcomes after conducting advanced vs. traditional sperm selection methods. Among those that also assessed sperm quality/functionality parameters (12/47), there was a consensus (10/12; 83.3%) about the beneficial effect of advanced sperm selection methods on these variables. In conclusion, the application of advanced sperm selection methods improves ART outcomes. In spite of this, as no differences in the reproductive efficiency between advanced methods has been reported, none can be pointed out as a gold standard to be conducted routinely. Further research addressing whether the efficiency of each method relies on the etiology of infertility is warranted.
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Affiliation(s)
- Jordi Ribas-Maynou
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Isabel Barranco
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40126 Bologna, Italy
- Correspondence: (J.R.-M.); (I.B.); Tel.: +34-972-419-514 (J.R.-M.); +39-051-209-7011 (I.B.); Fax: +34-972-418-150 (J.R.-M.)
| | - Maria Sorolla-Segura
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Llavanera
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Ariadna Delgado-Bermúdez
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
| | - Marc Yeste
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, 17003 Girona, Spain
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, 17003 Girona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
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IMSI—Guidelines for Sperm Quality Assessment. Diagnostics (Basel) 2022; 12:diagnostics12010192. [PMID: 35054359 PMCID: PMC8774575 DOI: 10.3390/diagnostics12010192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/26/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Intracytoplasmic sperm injection (ICSI) is a widely used and accepted treatment of choice for oocyte fertilization. However, the quality of sperm selection depends on the accurate visualization of the morphology, which can be achieved with a high image resolution. We aim to correct the conviction, shown in a myriad of publications, that an ultra-high magnification in the range of 6000×–10,000× can be achieved with an optical microscope. The goal of observing sperm under the microscope is not to simply get a larger image, but rather to obtain more detail—therefore, we indicate that the optical system’s resolution is what should be primarily considered. We provide specific microscope system setup recommendations sufficient for most clinical cases that are based on our experience showing that the optical resolution of 0.5 μm allows appropriate visualization of sperm defects. Last but not least, we suggest that mixed research results regarding the clinical value of IMSI, comparing to ICSI, can stem from a lack of standardization of microscopy techniques used for both ICSI and IMSI.
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Ghasemian F, Bahadori MH, Hosseini Kolkooh SZ, Esmaeili M. Using Deep Learning Algorithm: The Study of Sperm Head Vacuoles and Its Correlation with Protamine mRNA Ratio. CELL JOURNAL 2022; 24:7-14. [PMID: 35182059 PMCID: PMC8876261 DOI: 10.22074/cellj.2022.7448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/15/2020] [Indexed: 12/31/2022]
Abstract
Objective It is necessary to evaluate fertility effective agents to predict assisted reproduction outcomes. This study was
designed to examine sperm vacuole characteristics, and its association with sperm chromatin status and protamine-1
(PRM1) to protamine-2 (PRM2) ratio, to predict assisted pregnancy outcomes.
Materials and Methods In this experimental study, ninety eight semen samples from infertile men were classified based
on Vanderzwalmen’s criteria as follows: grade I: no vacuoles; grade II: <2 small vacuoles; grade III: <1 large vacuole
and grade IV: large vacuole with other abnormalities. The location, frequency and size of vacuoles were assessed
using high magnification, a deep learning algorithm, and scanning electron microscopy (SEM). The chromatin integrity,
condensation, viability and acrosome integrity, and protamination status were evaluated for vacuolated samples
by toluidine blue (TB) staining, aniline blue, triple staining, and CMA3 staining, respectively. Also, Protamine-1 and
protamine-2 genes expression was analysed by reverse transcription-quantitative polymerase chain reaction (PCR).
The assisted reproduction outcomes were also followed for each cycle.
Results The results show a significant correlation between the vacuole size (III and IV) and abnormal sperm chromatin
condensation (P=0.03 and P=0.02, respectively), and also, protamine-deficient (P=0.04 and P=0.03, respectively).
The percentage of reacting acrosomes was significantly higher in the grades III and IV spermatozoa in comparison
with normal group. The vacuolated spermatozoa with grade IV showed a high protamine mRNA ratio (PRM-2 was
underexpressed, P=0.01). In the IVF cycles, we observed a negative association between sperm head vacuole and
fertilization rate (P=0.01). This negative association was also significantly observed in pregnancy and live birth rate in
the groups with grade III and IV (P=0.04 and P=0.03, respectively).
Conclusion The results of our study highlight the importance sperm parameters such as sperm head vacuole
characteristics, particularly those parameters with the potency of reflecting protamine-deficiency and in vitro fertilization/
intracytoplasmic sperm injection (IVF/ICSI) outcomes predicting.
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Affiliation(s)
- Fatemeh Ghasemian
- Department of Biology, Faculty of Science, University of Guilan, Rasht, Iran.
| | - Mohammad Hadi Bahadori
- Cellular and Molecular Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyedeh Zahra Hosseini Kolkooh
- Reproductive Health Research Center (IVF Center), Alzahra Educational and Remedial Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Esmaeili
- Reproductive Health Research Center (IVF Center), Alzahra Educational and Remedial Center, Guilan University of Medical Sciences, Rasht, Iran
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Molecular Profiling of Spermatozoa Reveals Correlations between Morphology and Gene Expression: A Novel Biomarker Panel for Male Infertility. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1434546. [PMID: 34604380 PMCID: PMC8485144 DOI: 10.1155/2021/1434546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
Choosing spermatozoa with an optimum fertilizing potential is one of the major challenges in assisted reproductive technologies (ART). This selection is mainly based on semen parameters, but the addition of molecular approaches could allow a more functional evaluation. To this aim, we used sixteen fresh sperm samples from patients undergoing ART for male infertility and classified them in the high- and poor-quality groups, on the basis of their morphology at high magnification. Then, using a DNA sequencing method, we analyzed the spermatozoa methylome to identify genes that were differentially methylated. By Gene Ontology and protein-protein interaction network analyses, we defined candidate genes mainly implicated in cell motility, calcium reabsorption, and signaling pathways as well as transmembrane transport. RT-qPCR of high- and poor-quality sperm samples allowed showing that the expression of some genes, such as AURKA, HDAC4, CFAP46, SPATA18, CACNA1C, CACNA1H, CARHSP1, CCDC60, DNAH2, and CDC88B, have different expression levels according to sperm morphology. In conclusion, the present study shows a strong correlation between morphology and gene expression in the spermatozoa and provides a biomarker panel for sperm analysis during ART and a new tool to explore male infertility.
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Zhou WJ, Huang C, Jiang SH, Ji XR, Gong F, Fan LQ, Zhu WB. Influence of sperm morphology on pregnancy outcome and offspring in in vitro fertilization and intracytoplasmic sperm injection: a matched case-control study. Asian J Androl 2021; 23:421-428. [PMID: 33533739 PMCID: PMC8269829 DOI: 10.4103/aja.aja_91_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Sperm morphology was once believed as one of the most predictive indicators of pregnancy outcome in assisted reproductive technology (ART). However, the impact of teratozoospermia on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes and its offspring remains inconclusive. In order to evaluate the influence of teratozoospermia on pregnancy outcome and newborn status after IVF and ICSI, a retrospective study was conducted. This was a matched case-control study that included 2202 IVF cycles and 2574 ICSI cycles and was conducted at the Reproductive and Genetic Hospital of CITIC-Xiangya in Changsha, China, from June 2013 to June 2018. Patients were divided into two groups based on sperm morphology: teratozoospermia and normal sperm group. The pregnancy outcome and newborn outcome were analyzed. The results indicated that couples with teratozoospermia had a significantly lower optimal embryo rate compared to those with normal sperm morphology in IVF (P = 0.007), while there were no statistically significant differences between the two groups in terms of the fertilization rate, cleavage rate, implantation rate, and pregnancy rate (all P > 0.05). Additionally, teratozoospermia was associated with lower infant birth weight in multiple births after IVF. With regard to ICSI, there was no significant difference in both pregnancy outcome and newborn outcome between the teratozoospermia and normal groups (both P > 0.05). Furthermore, no increase in the risk of birth defects occurred in the teratozoospermia group after IVF/ICSI. Consequently, we believe that teratozoospermia has limited predictive value for pregnancy outcomes in IVF/ICSI, and has little impact on the resulting offspring if multiple pregnancy is avoided.
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Affiliation(s)
- Wen-Jun Zhou
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410008, China
| | - Chuan Huang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410008, China.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha 410008, China
| | - Su-Hua Jiang
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410008, China
| | - Xi-Ren Ji
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410008, China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410008, China.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha 410008, China
| | - Li-Qing Fan
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410008, China.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha 410008, China
| | - Wen-Bing Zhu
- Institute of Reproductive and Stem Cell Engineering, Basic Medicine College, Central South University, Changsha 410008, China.,Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha 410008, China.,Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha 410008, China
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Teixeira DM, Miyague AH, Barbosa MAP, Navarro PA, Raine‐Fenning N, Nastri CO, Martins WP. Regular (ICSI) versus ultra-high magnification (IMSI) sperm selection for assisted reproduction. Cochrane Database Syst Rev 2020; 2:CD010167. [PMID: 32083321 PMCID: PMC7033651 DOI: 10.1002/14651858.cd010167.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Subfertility is a condition found in up to 15% of couples of reproductive age. Gamete micromanipulation, such as intracytoplasmic sperm injection (ICSI), is very useful for treating couples with compromised sperm parameters. An alternative method of sperm selection has been described; the spermatozoa are selected under high magnification (over 6000x) and used for ICSI. This technique, named intracytoplasmic morphologically selected sperm injection (IMSI), has a theoretical potential to improve reproductive outcomes among couples undergoing assisted reproduction techniques (ART). However, our previous version of this Cochrane Review was unable to find evidence that supported this possible beneficial effect. This is an update of Teixeira 2013. OBJECTIVES To identify, appraise, and summarise the available evidence regarding efficacy and safety of IMSI compared to ICSI in couples undergoing ART. SEARCH METHODS We searched for randomised controlled trials (RCTs) in these electronic databases: the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and in these trial registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We also handsearched the reference lists of included studies and similar reviews. We performed the last electronic search on 18 November 2019. SELECTION CRITERIA We only considered RCTs that compared ICSI and IMSI; we did not include quasi-randomised trials. We considered studies that permitted the inclusion of the same participant more than once (cross-over or per cycle trials) only if data regarding the first treatment of each participant were available. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, and assessment of the risk of bias and quality of the evidence; we solved disagreements by consulting a third review author. We corresponded with study investigators to resolve any queries, as required. MAIN RESULTS The updated search retrieved 535 records; we included 13 parallel-designed RCTs comparing IMSI and ICSI (four studies were added since the previous version), comprising 2775 couples (IMSI = 1256; ICSI = 1519). We are uncertain if IMSI improves live birth rates (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.89 to 1.39; 5 studies, 929 couples; I² = 1%), miscarriage rates per couple (RR 1.07, 95% CI 0.78 to 1.48; 10 studies, 2297 couples; I² = 0%, very-low quality evidence), and miscarriage rate per pregnancy (RR 0.90, 95% CI 0.68 to 1.20; 10 studies, 783 couples; I² = 0%, very-low quality evidence). We are uncertain if IMSI improves clinical pregnancy rates (RR 1.23, 95% CI 1.11 to 1.37; 13 studies, 2775 couples; I² = 47%, very-low quality evidence). None of the included studies reported congenital abnormalities. We judged the evidence for all outcomes to be of very low-quality. We downgraded the quality of the evidence due to limitations of the included studies (risk of bias), inconsistency of results, and a strong indication of publication bias. AUTHORS' CONCLUSIONS The current evidence from randomised controlled trials does not support or refute the clinical use of intracytoplasmic sperm injection (intracytoplasmic morphologically selected sperm injection (IMSI). We are very uncertain of the chances of having a live birth and of the risk of having a miscarriage. We found very low-quality evidence that IMSI may increase chances of a clinical pregnancy, which means that we are still very uncertain about any real difference. We did not find any trials reporting on the risk of congenital abnormalities. Well-designed and sufficiently powered trials are still required.
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Affiliation(s)
- Danielle M Teixeira
- Federal University of ParanáDepartment of Obstetrics and Gynecology181 General Carneiro StHospital de Clínicas da UFPRCuritibaParanáBrazil80.060‐900
| | - Andre H Miyague
- Hospital Universitario Evangelico de CuritibaDepartment of Obstetrics and GynecologyAlameda Augusto Stellfeld 1908CuritibaBrazil80730‐150
| | - Mariana AP Barbosa
- University of Sao PauloDepartment of Obstetrics and Gynecology, Medical School of Ribeirao PretoHospital das Clínicas da FMRP‐USP, 8 andar, Campus UniversitárioCampus Universitario da USPRibeirao PretoSão PauloBrazil14048‐900
| | - Paula A Navarro
- University of Sao PauloDepartment of Obstetrics and Gynecology, Medical School of Ribeirao PretoHospital das Clínicas da FMRP‐USP, 8 andar, Campus UniversitárioCampus Universitario da USPRibeirao PretoSão PauloBrazil14048‐900
| | - Nick Raine‐Fenning
- University of NottinghamDivision of Child Health, Obstetrics and Gynaecology, School of MedicineNurture FertilityThe East Midlands Fertility CentreNottinghamUKNG10 5QG
| | - Carolina O Nastri
- SEMEAR Fertilidade, Reproductive MedicineAv Aurea Apparecida Braghetto Machado, 220Ribeirao PretoSao PauloBrazil14021‐460
| | - Wellington P Martins
- SEMEAR Fertilidade, Reproductive MedicineAv Aurea Apparecida Braghetto Machado, 220Ribeirao PretoSao PauloBrazil14021‐460
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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:CD010461. [PMID: 31425620 PMCID: PMC6699650 DOI: 10.1002/14651858.cd010461.pub3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Assisted reproductive technologies (ART) including in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), combine gametes to enhance the probability of fertilisation and pregnancy. Advanced sperm selection techniques are increasingly employed in ART, most commonly in cycles utilising ICSI. Advanced sperm selection techniques are proposed to improve the chance that structurally intact and mature sperm with high DNA integrity are selected for fertilisation. Strategies include selection according to surface charge; sperm apoptosis; sperm birefringence; ability to bind to hyaluronic acid; and sperm morphology under ultra-high magnification. These techniques are intended to improve ART outcomes. OBJECTIVES To evaluate the effectiveness and safety of advanced sperm selection techniques on ART outcomes. SEARCH METHODS We conducted a systematic search of electronic databases (Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL via the Cochrane Register of Studies Online, MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL); trials registers (ClinicalTrials.gov, Current Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform); conference abstracts (Web of Knowledge); and grey literature (OpenGrey) for relevant randomised controlled trials (RCTs). We handsearched the reference lists of included studies and similar reviews. The search was conducted in June 2018. SELECTION CRITERIA We included RCTs comparing advanced sperm selection techniques versus standard IVF, ICSI, or another technique. We excluded studies of intracytoplasmic morphologically selected sperm injection (IMSI), as they are subject to a separate Cochrane Review. Primary outcomes measured were live birth and miscarriage per woman randomly assigned. Secondary outcome measures included clinical pregnancy per woman randomly assigned. Secondary adverse events measured included miscarriage per clinical pregnancy and foetal abnormality. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and risk of bias and extracted data. Any disagreements were resolved by consultation with a third review author. We consulted study investigators to resolve queries. Risk ratios (RRs) were calculated with 95% confidence intervals (CIs). We combined studies using a fixed-effect model. We evaluated the quality of the evidence using GRADE methods. MAIN RESULTS We included eight RCTs (4147 women). The quality of evidence ranged from very low to low. The main limitations were imprecision, performance bias, and attrition bias.Hyaluronic acid selected sperm-intracytoplasmic sperm injection (HA-ICSI) compared to ICSITwo RCTs compared the effects of HA-ICSI versus ICSI on live birth. The quality of the evidence was low. There may be little or no difference between groups: 25% chance of live birth with ICSI versus 24.5% to 31% with HA-ICSI (RR 1.09, 95% CI 0.97 to 1.23, 2903 women, I2 = 0%, low-quality evidence). Three RCTs reported on miscarriage. HA-ICSI may decrease miscarriage per woman randomly assigned: 7% chance of miscarriage with ICSI versus 3% to 6% chance with HA-ICSI (RR 0.61, 95% CI 0.45 to 0.83, 3005 women, I2 = 0%, low-quality evidence) and per clinical pregnancy: 20% chance of miscarriage with ICSI compared to 9% to 16% chance with HA-ICSI (RR 0.62, 95% CI 0.46 to 0.82, 1065 women, I2 = 0%, low-quality evidence). Four RCTs reported on clinical pregnancy. There may be little or no difference between groups: 37% chance of pregnancy with ICSI versus 34% to 40% chance with HA-ICSI (RR 1.00, 95% CI 0.92 to 1.09, 3492 women, I2 = 0%, low-quality evidence).HA-ICSI compared to SpermSlowOne RCT compared HA-ICSI to SpermSlow. The quality of the evidence was very low. We are uncertain whether HA-ICSI improves live birth compared to SpermSlow (RR 1.13, 95% CI 0.64 to 2.01, 100 women) or clinical pregnancy (RR 1.05, 95% CI 0.66 to 1.68, 100 women). We are uncertain whether HA-ICSI reduces miscarriage per woman (RR 0.80, 95% CI 0.23 to 2.81, 100 women) or per clinical pregnancy (RR 0.76, 95% CI 0.24 to 2.44, 41 women).Magnetic-activated cell sorting (MACS) compared to ICSIOne RCT compared MACS to ICSI for live birth; three reported clinical pregnancy; and two reported miscarriage. The quality of the evidence was very low. We are uncertain whether MACS improves live birth (RR 1.95, 95% CI 0.89 to 4.29, 62 women) or clinical pregnancy (RR 1.05, 95% CI 0.84 to 1.31, 413 women, I2 = 81%). We are also uncertain if MACS reduces miscarriage per woman (RR 0.95, 95% CI 0.16 to 5.63, 150 women, I2 = 0%) or per clinical pregnancy (RR 0.51, 95%CI 0.09 to 2.82, 53 women, I2=0)Zeta sperm selection compared to ICSIOne RCT evaluated Zeta sperm selection. The quality of the evidence was very low. We are uncertain of the effect of Zeta sperm selection on live birth (RR 2.48, 95% CI 1.34 to 4.56, 203 women) or clinical pregnancy (RR 1.82, 95% CI 1.20 to 2.75, 203 women). We are also uncertain if Zeta sperm selection reduces miscarriage per woman (RR 0.73, 95% CI 0.16 to 3.37, 203 women) or per clinical pregnancy (RR 0.41, 95% CI 0.10 to 1.68, 1 RCT, 62 women).MACS compared to HA-ICSIOne RCT compared MACS to HA-ICSI. This study did not report on live birth. The quality of the evidence was very low. We are uncertain of the effect on miscarriage per woman (RR 1.52, 95% CI 0.10 to 23.35, 78 women) or per clinical pregnancy (RR 1.06, 95% CI 0.07 to 15.64, 37 women). We are also uncertain of the effect on clinical pregnancy (RR 1.44, 95% CI 0.91 to 2.27, 78 women). AUTHORS' CONCLUSIONS The evidence suggests that sperm selected by hyaluronic acid binding may have little or no effect on live birth or clinical pregnancy but may reduce miscarriage. We are uncertain of the effect of Zeta sperm selection on live birth, clinical pregnancy, and miscarriage due principally to the very low quality of the evidence for this intervention. We are uncertain of the effect of the other selection techniques on live birth, miscarriage, or pregnancy.Further high-quality studies, including the awaited data from the identified ongoing studies, are required to evaluate whether any of these advanced sperm selection techniques can be recommended for use in routine practice.
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Affiliation(s)
- Sam Lepine
- Capital and Coast District Health BoardDepartment of Obstetrics and GynaecologyWellingtonNew Zealand
| | - Simon McDowell
- Queensland Fertility Group Research Foundation55 Little Edward St, Level 2 Boundary CourtSpring HillBrisbaneQueenslandAustralia4000
| | - Leigh M Searle
- Royal Women's HospitalReproductive ServicesMelbourneAustralia
| | - Ben Kroon
- Queensland Fertility Group Research Foundation55 Little Edward St, Level 2 Boundary CourtSpring HillBrisbaneQueenslandAustralia4000
- The University of QueenslandBrisbaneQueenslandAustralia4072
| | - Demián Glujovsky
- CEGYR (Centro de Estudios en Genética y Reproducción)Reproductive MedicineViamonte 1432,Buenos AiresArgentina
| | - Anusch Yazdani
- Queensland Fertility Group Research Foundation55 Little Edward St, Level 2 Boundary CourtSpring HillBrisbaneQueenslandAustralia4000
- The University of QueenslandBrisbaneQueenslandAustralia4072
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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; 35:1665-1674. [PMID: 29946759 DOI: 10.1007/s10815-018-1242-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The main aim of our study was to evaluate the benefit of the use of non-apoptotic spermatozoa selected by magnetic-activated cell sorting (MACS) for ICSI procedures for couples in which the women had good prognoses and the male factor of infertility was teratozoospermia. METHODS Twenty-six couples were treated with ICSI after MACS selection of non-apoptotic spermatozoa following a sibling oocyte approach. Half of the oocytes were microinjected with conventionally prepared spermatozoa, and the other half were microinjected with non-apoptotic, MACS-selected spermatozoa. To assess the influence of MACS selection of spermatozoa on the outcomes of the ICSI cycles, the fertilization, embryo quality, pregnancy, and delivery rates were evaluated and compared between the sibling oocyte groups. RESULTS When subpopulations of couples according to female age were analyzed, a significant difference in quality of blastocyst was observed. More precisely, in a group that was treated with MACS-ICSI, a higher percentage of good quality blastocysts was found among women older than 30 years (75.0 vs. 33.3%; P = 0.028), while there was no difference among younger women. If all included couples were compared regardless of age, no significant difference was observed in the outcome of the ICSI/MACS-ICSI cycles in terms of oocytes and embryos. Additionally, after the ICSI and MACS-ICSI procedures, the morphologies of the prepared spermatozoa were compared. Results showed that the overall percentage of morphologically normal spermatozoa did not differ significantly between the ICSI and MACS-ICSI procedures. However, detailed analyses of the morphologically abnormal spermatozoa revealed significantly more spermatozoa with abnormal tails after MACS-ICSI procedure, which may be potential consequence of the selection procedure. Moreover, the trends towards less spermatozoa with abnormal heads and towards more spermatozoa with abnormal necks and midpieces after MACS-ICSI procedure were revealed, although the differences were not significant. CONCLUSIONS Couples dealing with male infertility due to teratozoospermia can benefit from MACS selection of spermatozoa with higher percentage of good quality blastocysts but only when the woman is older than 30 years.
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Affiliation(s)
- Martin Stimpfel
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia.
| | - Ivan Verdenik
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia
| | - Branko Zorn
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia
| | - Irma Virant-Klun
- Department of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000, Ljubljana, SI, Slovenia
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10
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Gaspard O, Vanderzwalmen P, Wirleitner B, Ravet S, Wenders F, Eichel V, Mocková A, Spitzer D, Jouan C, Gridelet V, Martens H, Henry L, Zech H, d'Hauterive SP, Nisolle M. Impact of high magnification sperm selection on neonatal outcomes: a retrospective study. J Assist Reprod Genet 2018; 35:1113-1121. [PMID: 29607458 DOI: 10.1007/s10815-018-1167-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/16/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to compare the effect of the deselection of spermatozoa presenting vacuole-like structures using IMSI (intracytoplasmic morphologically selected sperm injection) with ICSI (intracytoplasmic sperm injection) by means of neonatal outcomes. METHODS In a retrospective two-center analysis, a total of 848 successful IMSI or ICSI cycles ending with a live birth, induced abortion, or intrauterine fetal death (IUFD) were included. RESULTS The IMSI and ICSI groups included 332 and 655 babies or fetuses, respectively. The parents were older in the IMSI group than in the ICSI group (mothers were 35.1 vs 32.9 years, and fathers were 39.1 vs 36.2 years). The multiple pregnancy rate was higher in the IMSI group. The mean pregnancy duration and mean birth weight were almost identical in both groups. There was no significant difference in major congenital malformations between the two groups. However, this rate was decreased in the IMSI group compared to that in the ICSI group (1.8 vs 3.2%), the difference being mainly found in singletons (1.4 vs 3.3%). Boys were more often affected than girls in both groups. The percentages of chromosomal abnormalities did not differ between the IMSI and ICSI groups (0.6 and 0.8%). The reported congenital malformations mainly affected the heart, urogenital, and musculoskeletal systems. CONCLUSIONS In the present study, the malformation rates observed in the IMSI and ICSI groups were not significantly different, even if slightly lower after IMSI. However, the observed difference followed the same trends observed in previous reports, indicating the possible impact of IMSI on decreasing congenital malformation occurrences. This highlights the necessity to prospectively evaluate the impact of IMSI on neonatal outcome after IVF treatment.
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Affiliation(s)
- Olivier Gaspard
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
| | | | | | - Stéphanie Ravet
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Frédéric Wenders
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | | | - Alice Mocková
- Department of Neonatology, Faculty of Medicine in Pilsen and University Hospital, Charles University in Prague, Prague, Czech Republic
| | | | - Caroline Jouan
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Virginie Gridelet
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium.,GIGA I3, Center of Immunoendocrinology, University of Liège, Liège, Belgium
| | - Henri Martens
- GIGA I3, Center of Immunoendocrinology, University of Liège, Liège, Belgium
| | - Laurie Henry
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Herbert Zech
- IVF-Centers Prof. Zech, Bregenz, Austria.,IVF-Centers Prof. Zech, Salzburg, Austria
| | - Sophie Perrier d'Hauterive
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Michelle Nisolle
- Centre de Procréation Médicalement Assistée - ULiège, Centre Hospitalier Universitaire de Liège, Liège, Belgium
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11
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Berkovitz A, Dekel Y, Goldstein R, Bsoul S, Machluf Y, Bercovich D. The significance of human spermatozoa vacuoles can be elucidated by a novel procedure of array comparative genomic hybridization. Hum Reprod 2018; 33:563-571. [DOI: 10.1093/humrep/dey019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/17/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arie Berkovitz
- Sackler Faculty of Medicine, Tel Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Yaron Dekel
- Shamir Research Institute, University of Haifa, PO Box 97, Kazerin 1290000,Israel
- GGA—Galil Genetic Analysis Ltd., PO Box 3664, Kazerin 1290000, Israel
- Tel-Hai College, Upper Galilee 1220800,Israel
- Zefat Academic College, Zefat 1320611,Israel
| | - Revital Goldstein
- GGA—Galil Genetic Analysis Ltd., PO Box 3664, Kazerin 1290000, Israel
- Tel-Hai College, Upper Galilee 1220800,Israel
| | - Shhadeh Bsoul
- GGA—Galil Genetic Analysis Ltd., PO Box 3664, Kazerin 1290000, Israel
| | - Yossy Machluf
- Specialist in the Fields of Genetics, Epidemiology and Molecular Biology, Rehovot 7661509,
Israel
| | - Dani Bercovich
- GGA—Galil Genetic Analysis Ltd., PO Box 3664, Kazerin 1290000, Israel
- Tel-Hai College, Upper Galilee 1220800,Israel
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12
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Jeve YB, Potdar N, Blower JA, Gelbaya T. Strategies to improve fertilisation rates with assisted conception: a systematic review. HUM FERTIL 2017; 21:229-247. [PMID: 28545312 DOI: 10.1080/14647273.2017.1324182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Successful fertilisation is one of the key steps determining success of assisted conception. Various factors including sperm or oocyte pathology and environmental factors have a significant impact on fertilisation rates. This systematic review is aimed to evaluate the existing evidence about factors affecting fertilisation and strategies to improve fertilisation rates. A literature search was performed using Ovid MEDLINE ® (Jan 1950-April 2016), EMBASE (Jan 1950-April 2016), Ovid OLDMEDLINE ®, Pre-MEDLINE (Jan 1950-April 2016) and the Cochrane Library. Relevant key words were used to combine sets of results and a total 243 papers were screened. Only qualitative analysis was performed, as there was major heterogeneity in study design and methodology for quantitative synthesis. Factors affecting fertilisation were divided into sperm- and oocyte-related factors. The methods to improve fertilisation rates were grouped together based on the approach used to improve fertilisation rates. Optimising laboratory condition and procedural effects in techniques is associated with improved fertilisation rates. Various techniques are described to improve fertilisation rates including assisted oocyte activation, physiological intracytoplasmic sperm injection (PICSI) and intracytoplasmic morphologically selected sperm injection (IMSI). This review highlights the promising strategies under research to enhance fertilisation rates. Adequately powered multicentre randomised trials are required to evaluate these techniques before considering clinical application.
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Affiliation(s)
- Yadava Bapurao Jeve
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK
| | - Neelam Potdar
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK.,b Reproductive Sciences Section , University of Leicester , Leicester , UK
| | - Jane A Blower
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK
| | - Tarek Gelbaya
- a Leicester Fertility Centre , University Hospitals of Leicester , Leicester , UK
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OMIDI MARJAN, FARAMARZI AZITA, AGHARAHIMI AZAM, KHALILI MOHAMMADALI. Noninvasive imaging systems for gametes and embryo selection in IVF programs: a review. J Microsc 2017; 267:253-264. [DOI: 10.1111/jmi.12573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 12/30/2022]
Affiliation(s)
- MARJAN OMIDI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
| | - AZITA FARAMARZI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
| | - AZAM AGHARAHIMI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
| | - MOHAMMAD ALI KHALILI
- Research and Clinical Center for Infertility; Shahid Sadoughi University of Medical Sciences; Yazd Iran
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14
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Champroux A, Torres-Carreira J, Gharagozloo P, Drevet JR, Kocer A. Mammalian sperm nuclear organization: resiliencies and vulnerabilities. Basic Clin Androl 2016; 26:17. [PMID: 28031843 PMCID: PMC5175393 DOI: 10.1186/s12610-016-0044-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/12/2016] [Indexed: 01/07/2023] Open
Abstract
Sperm cells are remarkably complex and highly specialized compared to somatic cells. Their function is to deliver to the oocyte the paternal genomic blueprint along with a pool of proteins and RNAs so a new generation can begin. Reproductive success, including optimal embryonic development and healthy offspring, greatly depends on the integrity of the sperm chromatin structure. It is now well documented that DNA damage in sperm is linked to reproductive failures both in natural and assisted conception (Assisted Reproductive Technologies [ART]). This manuscript reviews recent important findings concerning - the unusual organization of mammalian sperm chromatin and its impact on reproductive success when modified. This review is focused on sperm chromatin damage and their impact on embryonic development and transgenerational inheritance.
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Affiliation(s)
- A. Champroux
- GReD “Genetics, Reproduction & Development” Laboratory, UMR CNRS 6293, INSERM U1103, Clermont Université, BP60026 - TSA60026, 63178 Aubière cedex, France
| | - J. Torres-Carreira
- Centro Universitário Rio Preto, UNIRP, Rodovia Br153, Km 69, CEP15093-450 São José do Rio Preto, São Paulo Brazil
| | - P. Gharagozloo
- CellOxess LLC, 830 Bear Tavern Road, Ewing, NJ 08628 USA
| | - J. R. Drevet
- GReD “Genetics, Reproduction & Development” Laboratory, UMR CNRS 6293, INSERM U1103, Clermont Université, BP60026 - TSA60026, 63178 Aubière cedex, France
| | - A. Kocer
- GReD “Genetics, Reproduction & Development” Laboratory, UMR CNRS 6293, INSERM U1103, Clermont Université, BP60026 - TSA60026, 63178 Aubière cedex, France
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15
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Gatimel N, Parinaud J, Leandri RD. Intracytoplasmic morphologically selected sperm injection (IMSI) does not improve outcome in patients with two successive IVF-ICSI failures. J Assist Reprod Genet 2016; 33:349-355. [PMID: 26754750 DOI: 10.1007/s10815-015-0645-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Assessment of sperm morphology has been reconsidered since 2001 with the development of motile sperm organelle morphology examination (MSOME). This observation technique that combines high magnification microscopy and the Nomarski interference contrast makes it possible to select spermatozoa with as few vacuoles as possible before microinjection into the oocyte (intracytoplasmic morphologically selected sperm injection, IMSI). More than 10 years after the development of IMSI, the indications of the IMSI technique and its ability to increase pregnancy and/or birthrates (compared with conventional ICSI) are still subject to debate. We aimed to better define the interest of IMSI in the third attempt. METHODS We assessed the benefit of IMSI by carrying out a retrospective comparative study between IMSI and conventional ICSI during a third ART attempt. Two hundred sixteen couples with two previous ICSI failures were studied between February 2010 and June 2014. RESULTS IMSI did not significantly improve the clinical outcomes compared with ICSI, either for implantation (12 vs 10%), clinical pregnancy (23 vs 21%), or live birth rates (20 vs 19%). CONCLUSION This study provides supplementary arguments for not achieving IMSI procedure in the third attempt after two previous ICSI failures.
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Affiliation(s)
- N Gatimel
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 Avenue de Grande Bretagne, 31059, Toulouse, France. .,Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), 330 Avenue de Grande Bretagne, 31059, Toulouse, France.
| | - J Parinaud
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 Avenue de Grande Bretagne, 31059, Toulouse, France.,Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), 330 Avenue de Grande Bretagne, 31059, Toulouse, France
| | - R D Leandri
- Service de Médecine de la Reproduction, Hôpital Paule de Viguier, CHU Toulouse, 330 Avenue de Grande Bretagne, 31059, Toulouse, France.,Université Paul Sabatier Toulouse-III, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), 330 Avenue de Grande Bretagne, 31059, Toulouse, France
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16
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Setti AS, Braga DP, Figueira RC, Iaconelli A, Borges E. Intracytoplasmic morphologically selected sperm injection results in improved clinical outcomes in couples with previous ICSI failures or male factor infertility: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014; 183:96-103. [DOI: 10.1016/j.ejogrb.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/06/2014] [Accepted: 10/04/2014] [Indexed: 10/24/2022]
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17
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Ebner T, Oppelt P, Wöber M, Staples P, Mayer RB, Sonnleitner U, Bulfon-Vogl S, Gruber I, Haid AE, Shebl O. Treatment with Ca2+ ionophore improves embryo development and outcome in cases with previous developmental problems: a prospective multicenter study. Hum Reprod 2014; 30:97-102. [PMID: 25376461 DOI: 10.1093/humrep/deu285] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does calcium ionophore treatment (A23187, calcimycin) improve embryo development and outcome in patients with a history of developmental problems/arrest? SUMMARY ANSWER Application of A23187 leads to increased rates of cleavage to 2-cell stage, blastocyst formation and clinical pregnancy/live birth. WHAT IS KNOWN ALREADY Studies on lower animals indicate that changes in intracellular free calcium trigger and regulate the events of cell division. In humans, calcium fluctuations were detected with a peak shortly before cell division. Interestingly, these calcium oscillations disappeared in arrested embryos. Mitotic division blocked with a Ca(2+) chelator could be restored by means of ionophores in an animal model. STUDY DESIGN, SIZE, DURATION This prospective, multicenter (five Austrian centers), uncontrolled intervention study (duration 1 year) includes 57 patients who provided informed consent. PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria were complete embryo developmental arrest in a previous cycle (no transfer), complete developmental delay (no morula/blastocyst on Day 5), or reduced blastocyst formation on Day 5 (≤15%). Severe male factor patients and patients with <30% fertilization rate after ICSI were excluded because these would be routine indications for ionophore usage. The total of the 57 immediately preceding cycles in the same patients constituted the control cycles/control group. In the treatment cycles, all metaphase II-oocytes were exposed to a commercially available ready-to-use ionophore for 15 min immediately after ICSI. After a three-step washing procedure, in vitro culture was performed as in the control cycles, up to blastocyst stage when achievable. MAIN RESULTS AND THE ROLE OF CHANCE Fertilization rate did not differ (75.4 versus 73.2%); however, further cleavage to 2-cell stage was significantly higher (P < 0.001) in the ionophore group (98.5%) when compared with the control cycles (91.9%). In addition, significantly more (P < 0.05) blastocysts formed on Day 5 in the study compared with the control group (47.6 versus 5.5%, respectively) and this was associated with a significant increase (P < 0.01) in the rates of implantation (44.4 versus 12.5%), clinical pregnancy (45.1 versus 12.8%) and live birth (45.1 versus 12.8%). All babies born at the time of writing (22/28) were healthy. LIMITATIONS, REASONS FOR CAUTION The frequency of patients showing embryo developmental problems was expected to be low; therefore, a multicenter approach was chosen in order to increase sample size. In one-third of the cycles, the clinician or patient requested a change of stimulation protocol; however, this did not influence the developmental rate of embryos. WIDER IMPLICATIONS OF THE FINDINGS This is the first evidence that developmental incompetence of embryos is an additional indication for ionophore treatment. The present approach is exclusively for overcoming cleavage arrest. STUDY FUNDING/COMPETING INTERESTS No funding received. T.E. reports fees from Gynemed, outside the submitted work. All co-authors have no interest to declare.
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Affiliation(s)
- T Ebner
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes-Frauen-und Kinderklinik, Krankenhausstr. 26-30, A-4020 Linz, Austria Faculty of Medicine, Johannes Kepler University, 4020 Linz, Austria
| | - P Oppelt
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes-Frauen-und Kinderklinik, Krankenhausstr. 26-30, A-4020 Linz, Austria Faculty of Medicine, Johannes Kepler University, 4020 Linz, Austria
| | - M Wöber
- Kinderwunschzentrum Goldenes Kreuz, 1090 Vienna, Austria
| | - P Staples
- Medical University, 8010 Graz, Austria
| | - R B Mayer
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes-Frauen-und Kinderklinik, Krankenhausstr. 26-30, A-4020 Linz, Austria Faculty of Medicine, Johannes Kepler University, 4020 Linz, Austria
| | | | - S Bulfon-Vogl
- Sterignost, Institut für Kinderwunschbehandlung, 9020 Klagenfurt, Austria
| | - I Gruber
- Kinderwunschambulanz im Landesklinikum St Pölten, 3100 St Pölten, Austria
| | - A E Haid
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes-Frauen-und Kinderklinik, Krankenhausstr. 26-30, A-4020 Linz, Austria Faculty of Medicine, Johannes Kepler University, 4020 Linz, Austria
| | - O Shebl
- Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes-Frauen-und Kinderklinik, Krankenhausstr. 26-30, A-4020 Linz, Austria Faculty of Medicine, Johannes Kepler University, 4020 Linz, Austria
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McDowell S, Kroon B, Ford E, Hook Y, Glujovsky D, Yazdani A. Advanced sperm selection techniques for assisted reproduction. Cochrane Database Syst Rev 2014:CD010461. [PMID: 25348679 DOI: 10.1002/14651858.cd010461.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) bring together gametes outside of the body to enhance the probability of fertilisation and pregnancy. Advanced sperm selection techniques are increasingly being employed in ART, most commonly in cycles utilising ICSI. Advanced sperm selection techniques are thought to improve the chance that structurally intact and mature sperm with high DNA integrity are selected for fertilisation. Advanced sperm selection strategies include selection according to surface charge; sperm apoptosis; sperm birefringence; ability to bind to hyaluronic acid; and sperm morphology under ultra-high magnification. These techniques theoretically improve ART outcomes. OBJECTIVES To evaluate the impact of advanced sperm selection techniques on ART outcomes. SEARCH METHODS Systematic search of electronic databases (Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Health Science Information Database (LILACS)), trials registers (ClinicalTrials.gov, Current Controlled Trials, World Health Organization International Clinical Trials Registry Platform), conference abstracts (Web of Knowledge) and grey literature (OpenGrey) for relevant randomised controlled trials. We handsearched the reference lists of included studies and similar reviews. The search was conducted in May 2014. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing an advanced sperm selection technique versus standard IVF or ICSI or versus another advanced sperm selection technique. We excluded studies of sperm selection using ultra-high magnification (intracytoplasmic morphologically selected sperm injection, or IMSI), as they are the subject of a separate Cochrane review. Quasi-randomised and pseudo-randomised trials were excluded. Our primary outcome measure was live birth rate per woman randomly assigned. Secondary outcome measures included clinical pregnancy per woman randomly assigned, miscarriage per clinical pregnancy and fetal abnormality per clinical pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility of studies and risk of bias, and performed data extraction. Disagreements were resolved by consultation with a third review author. Study investigators were consulted to resolve other queries that arose. Risk ratios (RRs) were calculated with 95% confidence intervals (CIs). We planned to combine studies using a fixed-effect model, if sufficient data were available. The quality of the evidence was evaluated using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS Two RCTs were included in the review. Both evaluated sperm selection by hyaluronanic acid binding for ICSI, but only one reported live births. No studies were identified that were related to surface charge selection, sperm apoptosis or sperm birefringence.One RCT compared hyaluronanic acid binding versus conventional ICSI. Live birth was not reported. Evidence was insufficient to show whether there was a difference between groups in clinical pregnancy rates (RR 1.01, 95% CI 0.84 to 1.22, one RCT, 482 women). This evidence was deemed to be of low quality, mainly as the result of poor reporting of methods and findings. Miscarriage data were unclear, and fetal abnormality rates were not reported.The other RCT compared two different hyaluronanic acid binding techniques, SpermSlow and physiological intracytoplasmic sperm injection (PISCI). Evidence was insufficient to indicate whether there was a difference between groups in rates of live birth (RR 1.16, 95% CI 0.65 to 2.05, one RCT, 99 women), clinical pregnancy (RR 1.07, 95% CI 0.67 to 1.71, one RCT, 99 women) or miscarriage (RR 0.76, 95% CI 0.24 to 2.44, one RCT, 41 women). The evidence for these comparisons was deemed to be of low quality, as it was limited by imprecision and poor reporting of study methods. Fetal abnormality rates were not reported. AUTHORS' CONCLUSIONS Evidence was insufficient to allow review authors to determine whether sperm selected by hyaluronanic acid binding improve live birth or pregnancy outcomes in ART, and no clear data on adverse effects were available. Evidence was also insufficient to show whether there is a difference in efficacy between the hyaluronic acid binding methods SpermSlow and PICSI. No randomised evidence evaluating sperm selection by sperm apoptosis, sperm birefringence or surface charge was found.Further studies of suitable quality are required to evaluate whether any of these advanced sperm selection techniques can be recommended for use in clinical practice.
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Affiliation(s)
- Simon McDowell
- Queensland Fertility Group Research Foundation, 55 Little Edward St, Level 2 Boundary Court, Spring Hill, Brisbane, Queensland, Australia, 4000
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19
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Vingris L, Setti AS, De Almeida Ferreira Braga DP, De Cassia Savio Figueira R, Iaconelli A, Borges E. Sperm morphological normality under high magnification predicts laboratory and clinical outcomes in couples undergoing ICSI. HUM FERTIL 2014; 18:81-6. [DOI: 10.3109/14647273.2014.956812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Zhu WJ, Li J. A simple sperm nuclear vacuole assay with propidium iodide. Andrologia 2014; 47:779-85. [DOI: 10.1111/and.12328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- W.-J. Zhu
- Department of Developmental and Regenerative Biology; College of Life Science and Technology; Jinan University; Guangzhou China
| | - J. Li
- Department of Pathophysiology; Medical College; Jinan University; Guangzhou China
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Sifer C, El Khattabi L, Dupont C, Sermondade N, Herbemont C, Porcher R, Cedrin-Durnerin I, Faure C, Lévy R, Grynberg M, Poncelet C, Hugues JN. Could sperm grade under high magnification condition predict IMSI clinical outcome? Eur J Obstet Gynecol Reprod Biol 2014; 181:189-94. [PMID: 25150959 DOI: 10.1016/j.ejogrb.2014.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/28/2014] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether injection of first-best morphology grade selected spermatozoa improves live birth rate (LBR) compared to intracytoplasmic morphologically selected sperm injection (IMSI) using second-best grade sperm. STUDY DESIGN In this prospective observational study, 132 patients were enrolled. Inclusion criteria were the presence of severe male factor (normal spermatozoa <10% in fresh ejaculated semen and <10% in selected sperm according to David's classification) associated with ≤2 previous ICSI failure. Results of IMSI performed with either first- or second-best morphology grade spermatozoa (according to Vanderzwalmen's classification) were compared. IMSI attempts performed using mixed first- and second-best grade spermatozoa were excluded (n=41). The primary endpoint was LBR. RESULTS LBR following IMSI was not statistically different using first- (33.3% (13/39)) or second-best morphology grade spermatozoa (28.9% (15/52)). Our study shows that sperm grading under high magnification using Vanderzwalmen's classification is not correlated to IMSI outcome. CONCLUSION We do not validate Vanderzwalmen classification in our external and prospective series. These results point out the need for improving our knowledge about the impact of observed vacuoles under high magnification condition.
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Affiliation(s)
- Christophe Sifer
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France.
| | - Laïla El Khattabi
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France
| | - Charlotte Dupont
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France
| | - Nathalie Sermondade
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France
| | - Charlène Herbemont
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France
| | - Raphael Porcher
- Service de Biostatistique et d'Informatique Médicale, Centre Hospitalier Universitaire Saint-Louis, Assistance Publique - Hôpitaux de Paris, 75475 Paris cedex 10, France
| | - Isabelle Cedrin-Durnerin
- Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France; Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France
| | - Céline Faure
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France
| | - Rachel Lévy
- Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France
| | - Christophe Poncelet
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France
| | - Jean-Noël Hugues
- Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France
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22
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Milachich T. New advances of preimplantation and prenatal genetic screening and noninvasive testing as a potential predictor of health status of babies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:306505. [PMID: 24783200 PMCID: PMC3982254 DOI: 10.1155/2014/306505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/13/2014] [Accepted: 02/15/2014] [Indexed: 11/18/2022]
Abstract
The current morphologically based selection of human embryos for transfer cannot detect chromosome aneuploidies. So far, only biopsy techniques have been able to screen for chromosomal aneuploidies in the in vitro fertilization (IVF) embryos. Preimplantation genetic diagnosis (PGD) or screening (PGS) involves the biopsy of oocyte polar bodies or embryonic cells and has become a routine clinical procedure in many IVF clinics worldwide, including recent development of comprehensive chromosome screening of all 23 pairs of chromosomes by microarrays for aneuploidy screening. The routine preimplantation and prenatal genetic diagnosis (PND) require testing in an aggressive manner. These procedures may be invasive to the growing embryo and fetus and potentially could compromise the clinical outcome. Therefore the aim of this review is to summarize not only the new knowledge on preimplantation and prenatal genetic diagnosis in humans, but also on the development of potential noninvasive embryo and fetal testing that might play an important role in the future.
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Affiliation(s)
- Tanya Milachich
- SAGBAL Dr. Shterev, IVF Unit, Hristo Blagoev 25-31, 1330 Sofia, Bulgaria
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23
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Expression of mesenchymal stem cells-related genes and plasticity of aspirated follicular cells obtained from infertile women. BIOMED RESEARCH INTERNATIONAL 2014; 2014:508216. [PMID: 24724084 PMCID: PMC3958784 DOI: 10.1155/2014/508216] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 12/25/2022]
Abstract
After removal of oocytes for in vitro fertilization, follicular aspirates which are rich in somatic follicular cells are discarded in daily medical practice. However, there is some evidence that less differentiated cells with stem cell characteristics are present among aspirated follicular cells (AFCs). The aim of this study was to culture AFCs in vitro and to analyze their gene expression profile. Using the RT2 Profiler PCR array, we investigated the expression profile of 84 genes related to stemness, mesenchymal stem cells (MCSs), and cell differentiation in AFCs enriched by hypoosmotic protocol from follicular aspirates of infertile women involved in assisted reproduction programme in comparison with bone marrow-derived mesenchymal stem cells (BM-MSCs) and fibroblasts. Altogether the expression of 57 genes was detected in AFCs: 16 genes (OCT4, CD49f, CD106, CD146, CD45, CD54, IL10, IL1B, TNF, VEGF, VWF, HDAC1, MITF, RUNX2, PPARG, and PCAF) were upregulated and 20 genes (FGF2, CASP3, CD105, CD13, CD340, CD73, CD90, KDR, PDGFRB, BDNF, COL1A1, IL6, MMP2, NES, NUDT6, BMP6, SMURF2, BMP4, GDF5, and JAG1) were downregulated in AFCs when compared with BM-MSCs. The genes which were upregulated in AFCs were mostly related to MSCs and connected with ovarian function, and differed from those in fibroblasts. The cultured AFCs with predominating granulosa cells were successfully in vitro differentiated into adipogenic-, osteogenic-, and pancreatic-like cells. The upregulation of some MSC-specific genes and in vitro differentiation into other types of cells indicated a subpopulation of AFCs with specific stemness, which was not similar to those of BM-MSCs or fibroblasts.
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24
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De Vos A, Polyzos NP, Verheyen G, Tournaye H. Intracytoplasmic morphologically selected sperm injection (IMSI): a critical and evidence-based review. Basic Clin Androl 2013; 23:10. [PMID: 25780572 PMCID: PMC4349780 DOI: 10.1186/2051-4190-23-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/02/2013] [Indexed: 01/01/2023] Open
Abstract
Introduced in 2001, intracytoplasmic morphologically selected sperm injection (IMSI) represents a more sophisticated way of ICSI whereby, prior to injection, the spermatozoon is selected at higher magnification. Doing so, the spermatozoon can be evaluated for fine integrity of its nucleus and the injection of a normal spermatozoon with a vacuole-free head can be assured. Additional research is needed to unravel the underlying mechanisms responsible for the presence of vacuoles in sperm heads. Associations with acrosome status, chromatin condensation, DNA fragmentation and sperm aneuploidy have been documented, however, controversy on their nature exists. Spermatozoon shape and large vacuoles are detected and deselected in conventional ICSI as well. However, the detection of subtle small vacuoles depends on the resolving power of the optical system and may impact oocyte fertilization, embryo development and implantation. Several comparative studies have indicated that the use of high-magnification sperm selection was associated with both higher pregnancy and delivery rates, whereas also lower miscarriage rates were observed. However, still to date randomized, well-powered studies to confirm these findings are scarce and show conflicting results. Hence, the most relevant indications for IMSI still remain to be determined. Two groups of patients have been put forward i.e. severe male-factor infertility patients and patients with a history of repeated ICSI failures. However, for both groups limited to no proof of any benefit does exist. IMSI is a time-consuming procedure at the expense of oocyte ageing. The lack of proof and understanding of its benefit does not justify its routine clinical application at present.
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Affiliation(s)
- Anick De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
| | - Nikolaos P Polyzos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
| | - Greta Verheyen
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
| | - Herman Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
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25
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Boitrelle F, Guthauser B, Alter L, Bailly M, Bergere M, Wainer R, Vialard F, Albert M, Selva J. High-magnification selection of spermatozoa prior to oocyte injection: confirmed and potential indications. Reprod Biomed Online 2013; 28:6-13. [PMID: 24268730 DOI: 10.1016/j.rbmo.2013.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 11/17/2022]
Abstract
Intracytoplasmic morphologically selected sperm injection (IMSI) involves the use of differential interference contrast microscopy at high magnification (at least ·6300) to improve the observation of live human spermatozoa (particularly by showing sperm head vacuoles that are not necessarily seen at lower magnifications) prior to intracytoplasmic sperm injection (ICSI) into the oocyte. However, a decade after IMSI’s introduction, the technique’s indications and ability to increase pregnancy and/or birth rates (relative to conventional ICSI) are subject to debate. In an attempt to clarify this debate, this work performed a systematic literature review according to the PRISMA guidelines. The PubMed database was searched from 2001 onwards with the terms ‘IMSI’, ‘MSOME’ and ‘high-magnification, sperm’. Out of 168 search results, 22 relevant studies reporting IMSI outcomes in terms of blastocyst, pregnancy, delivery and/or birth rates were selected and reviewed. The studies’ methodologies and results are described and discussed herein. In view of the scarcity of head-to-head IMSI versus ICSI studies, the only confirmed indication for IMSI is recurrent implantation failure following ICSI. All other potential indications of IMSI require further investigation.
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Affiliation(s)
- F Boitrelle
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France.
| | - B Guthauser
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
| | - L Alter
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
| | - M Bailly
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
| | - M Bergere
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
| | - R Wainer
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
| | - F Vialard
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
| | - M Albert
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
| | - J Selva
- Department of Reproductive Biology, Cytogenetics and Gynaecology, Poissy General Hospital, F-78303 Poissy, France; EA 2493, Versailles University of Medicine and Science, F-78000 Versailles, France
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The nature of human sperm head vacuoles: a systematic literature review. Basic Clin Androl 2013; 23:3. [PMID: 25780567 PMCID: PMC4346294 DOI: 10.1186/2051-4190-23-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/25/2013] [Indexed: 11/13/2022] Open
Abstract
Motile sperm organelle morphology examination (MSOME) involves the use of differential interference contrast microscopy (also called Nomarski contrast) at high magnification (at least 6300x) to improve the observation of live human spermatozoa. In fact, this technique evidences sperm head vacuoles that are not necessarily seen at lower magnifications - particularly if the vacuoles are small (i.e. occupying <4% of the sperm head’s area). However, a decade after MSOME's introduction, it is still not clear whether sperm head vacuoles are nuclear, acrosomal and/or membrane-related in nature. In an attempt to clarify this debate, we performed a systematic literature review in accordance with the PRISMA guidelines. The PubMed database was searched from 2001 onwards with the terms "MSOME", “human sperm vacuoles”, "high-magnification, sperm”. Out of 180 search results, 21 relevant English-language publications on the nature of human sperm head vacuoles were finally selected and reviewed. Our review of the literature prompted us to conclude that sperm-head vacuoles are nuclear in nature and are related to chromatin condensation failure and (in some cases) sperm DNA damage.
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27
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Small human sperm vacuoles observed under high magnification are pocket-like nuclear concavities linked to chromatin condensation failure. Reprod Biomed Online 2013; 27:201-11. [DOI: 10.1016/j.rbmo.2013.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 05/03/2013] [Accepted: 05/07/2013] [Indexed: 12/25/2022]
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28
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Knez K, Tomazevic T, Vrtacnik-Bokal E, Virant-Klun I. Developmental dynamics of IMSI-derived embryos: a time-lapse prospective study. Reprod Biomed Online 2013; 27:161-71. [DOI: 10.1016/j.rbmo.2013.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/29/2013] [Accepted: 04/02/2013] [Indexed: 10/27/2022]
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Teixeira DM, Barbosa MAP, Ferriani RA, Navarro PA, Raine-Fenning N, Nastri CO, Martins WP. Regular (ICSI) versus ultra-high magnification (IMSI) sperm selection for assisted reproduction. Cochrane Database Syst Rev 2013:CD010167. [PMID: 23884963 DOI: 10.1002/14651858.cd010167.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Subfertility is a condition found in up to 15% of couples of reproductive age. Gamete micromanipulation, such as intracytoplasmic sperm injection (ICSI), is very useful for treating couples with compromised sperm parameters. Recently a new method of sperm selection named 'motile sperm organelle morphology examination' (MSOME) has been described and the spermatozoa selected under high magnification (over 6000x) used for ICSI. This new technique, named intracytoplasmic morphologically selected sperm injection (IMSI), has a theoretical potential to improve reproductive outcomes among couples undergoing assisted reproduction techniques (ART). OBJECTIVES To compare the effectiveness and safety of IMSI and ICSI in couples undergoing ART. SEARCH METHODS We searched for randomised controlled trials (RCT) in electronic databases (Cochrane Menstrual Disorders and Subfertility Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS), trials registers (ClinicalTrials.gov, Current Controlled Trials, World Health Organization International Clinical Trials Registry Platform), conference abstracts (ISI Web of knowledge), and grey literature (OpenGrey); in addition, we handsearched the reference lists of included studies and similar reviews. We performed the last electronic search on 8 May 2013. SELECTION CRITERIA We considered only truly randomised controlled trials comparing ICSI and IMSI to be eligible; we did not include quasi or pseudo-randomised trials. We included studies that permitted the inclusion of the same participant more than once (cross-over or 'per cycle' trials) only if data regarding the first treatment of each participant were available. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, data extraction, and assessment of the risk of bias and we solved disagreements by consulting a third review author. We corresponded with study investigators in order to resolve any queries, as required. MAIN RESULTS The search retrieved 294 records; from those, nine parallel design studies were included, comprising 2014 couples (IMSI = 1002; ICSI = 1012). Live birth was evaluated by only one trial and there was no significant evidence of a difference between IMSI and ICSI (risk ratio (RR) 1.14, 95% confidence interval (CI) 0.79 to 1.64, 1 RCT, 168 women, I(2) = not applicable, low-quality evidence). IMSI was associated with a significant improvement in clinical pregnancy rate (RR 1.29, 95% CI 1.07 to 1.56, 9 RCTs, 2014 women, I(2) = 57%, very-low-quality evidence). We downgraded the quality of this evidence because of imprecision, inconsistency, and strong indication of publication bias. We found no significant difference in miscarriage rate between IMSI and ICSI (RR 0.82, 95% CI 0.59 to 1.14, 6 RCTs, 552 clinical pregnancies, I(2) = 17%, very-low-quality evidence). None of the included studies reported congenital abnormalities. AUTHORS' CONCLUSIONS Results from RCTs do not support the clinical use of IMSI. There is no evidence of effect on live birth or miscarriage and the evidence that IMSI improves clinical pregnancy is of very low quality. There is no indication that IMSI increases congenital abnormalities. Further trials are necessary to improve the evidence quality before recommending IMSI in clinical practice.
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Affiliation(s)
- Danielle M Teixeira
- Department ofObstetrics andGynecology,Medical School of Ribeirao Preto,University of Sao Paulo, Ribeirao Preto, Brazil
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Lo Monte G, Murisier F, Piva I, Germond M, Marci R. Focus on intracytoplasmic morphologically selected sperm injection (IMSI): a mini-review. Asian J Androl 2013; 15:608-15. [PMID: 23832017 DOI: 10.1038/aja.2013.54] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/11/2013] [Accepted: 04/08/2013] [Indexed: 11/09/2022] Open
Abstract
Intracytoplasmic sperm injection (ICSI) is the recommended treatment in many cases of male-factor infertility. Several studies have demonstrated a positive correlation between optimal sperm morphology and positive ICSI outcomes. In fact, spermatozoa with severe abnormalities of the head are well documented to be associated with low fertilisation, implantation and pregnancy rates. However, a spermatozoon which is classified as 'normal' by microscopic observation at low magnification could contain ultrastructural defects that impair both the fertilisation process and embryonic development. The intracytoplasmic morphologically selected sperm injection (IMSI) procedure changed the perception of how a spermatozoon suitable for injection should appear. Sperm selection is carried out at ×6000 magnification, allowing improved assessment of the sperm nucleus. Currently, standardized clinical indications for IMSI are lacking and the candidates are selected on the grounds of their medical history or of a careful analysis of the sperm suspension. Further prospective randomized studies are needed to confirm the advantages of IMSI in specific groups of patients. In addition to providing a brief overview of the IMSI procedure, this study aims to review the literature, which explains the theoretical basis and the clinical outcomes of this technique. Several reports show that IMSI is associated with improved implantation and clinical pregnancy rates as well as lower abortion rates when compared to ICSI. Although a possible correlation between the sperm's abnormal nucleus shape, increased DNA fragmentation and negative laboratory and clinical outcomes has been long investigated, the results are conflicting.
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Affiliation(s)
- Giuseppe Lo Monte
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Perdrix A, Rives N. Motile sperm organelle morphology examination (MSOME) and sperm head vacuoles: state of the art in 2013. Hum Reprod Update 2013; 19:527-41. [PMID: 23825157 DOI: 10.1093/humupd/dmt021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately 10 years after the first publication introducing the motile sperm organelle morphology examination (MSOME), many questions remained about sperm vacuoles: frequency, size, localization, mode of occurrence, biological significance and impact on male fertility potential. Many studies have tried to characterize sperm vacuoles, to determine the sperm abnormalities possibly associated with vacuoles, to test the diagnostic value of MSOME for male infertility or to question the benefits of intracytoplasmic morphologically selected sperm injection (IMSI). METHODS We searched PubMed for articles in the English language published in 2001-2012 regarding human sperm head vacuoles, MSOME and IMSI. RESULTS A bibliographic analysis revealed consensus for the following findings: (i) sperm vacuoles appeared frequently, often multiple and preferentially anterior; (ii) sperm vacuoles and sperm chromatin immaturity have been associated, particularly in the case of large vacuoles; (iii) teratozoospermia was a preferred indication of MSOME and IMSI. CONCLUSION The high-magnification system appears to be a powerful method to improve our understanding of human spermatozoa. However, its clinical use remains unclear in the fields of male infertility diagnosis and assisted reproduction techniques (ARTs).
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Affiliation(s)
- Anne Perdrix
- Reproductive Biology Laboratory-CECOS, EA 4308 "Gametogenesis and gamete quality", IRIB, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France.
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Is intracytoplasmic morphologically selected sperm injection effective in patients with infertility related to teratozoospermia or repeated implantation failure? Fertil Steril 2013; 100:62-8. [DOI: 10.1016/j.fertnstert.2013.02.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 02/25/2013] [Accepted: 02/28/2013] [Indexed: 11/22/2022]
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Setti AS, Paes de Almeida Ferreira Braga D, Iaconelli A, Aoki T, Borges E. Twelve years of MSOME and IMSI: a review. Reprod Biomed Online 2013; 27:338-52. [PMID: 23948449 DOI: 10.1016/j.rbmo.2013.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 01/05/2023]
Abstract
A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME) enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques. A promising method for observing spermatozoa, motile sperm organelle morphology examination (MSOME), enables the evaluation of the nuclear morphology of motile spermatozoa in real time at high magnification and has allowed the introduction of a modified microinjection procedure, intracytoplasmic morphologically selected sperm injection (IMSI). Since its development, several studies have intensively investigated the efficacy of MSOME and IMSI. The objective of the present study is to review the current literature on the MSOME and IMSI techniques.
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Affiliation(s)
- Amanda Souza Setti
- Sapientiae Institute - Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, São Paulo, SP 04503-040, Brazil; Fertility - Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, São Paulo, SP 01401-002, Brazil
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34
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Leandri RD, Gachet A, Pfeffer J, Celebi C, Rives N, Carre-Pigeon F, Kulski O, Mitchell V, Parinaud J. Is intracytoplasmic morphologically selected sperm injection (IMSI) beneficial in the first ART cycle? A multicentric randomized controlled trial. Andrology 2013; 1:692-7. [DOI: 10.1111/j.2047-2927.2013.00104.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - J. Pfeffer
- Laboratoire ZTP; Clinique de la DHUYS; Bagnolet; France
| | - C. Celebi
- Laboratoire de Biologie de la Reproduction; CMCO Schiltigheim; CHRU de Lille; Schiltigheim; France
| | - N. Rives
- Laboratoire de Biologie de la Reproduction-CECOS; EA 4308 « Gamétogenèse et Qualité du Gamète »; CHU Hôpitaux de Rouen; Rouen; France
| | - F. Carre-Pigeon
- Laboratoire de Biologie de la Reproduction-CECOS; CHU de Reims; Reims; France
| | - O. Kulski
- Laboratoire de Biologie de la Reproduction; Hôpital des 4 Villes; Sèvres; France
| | - V. Mitchell
- EA4308-Institut de la Biologie de la Reproduction; CHRU de Lille; Lille; France
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Intracytoplasmic morphologically selected sperm injection outcomes: the role of sperm preparation techniques. J Assist Reprod Genet 2013; 30:849-54. [PMID: 23547020 DOI: 10.1007/s10815-013-9989-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/20/2013] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To compare the results of intracytoplasmic morphologically selected sperm injection (IMSI) between cycles in which the swim-up (SUP) or the density gradient centrifugation (DGC) techniques were used for sperm preparation. METHODS We evaluated 70 IMSI cycles performed in women with age ≤ 37 years, undergoing IMSI as result of male factor. The couples were divided into two groups: DGC group (n = 26) and SUP group (n = 44). The groups were compared with regard to IMSI outcomes. RESULTS There were no significant differences between SUP and DGC groups regarding the number of follicles, oocytes, mature oocytes, oocyte yield and mature oocyte rate. Fertilization rate and high-quality embryos rate on day 5 of development were similar between SUP and DGC groups. Implantation, pregnancy and miscarriage rates were not statistically different between SUP and DGC groups (28.8 vs 33.3 %, 46.2 vs 57.1 % and 8.3 vs 4.2 %, respectively). CONCLUSIONS Both the SUP and the DGC techniques recover improved sperm fractions and result in similar IMSI outcomes. Further randomized trials analyzing both the quality of sperm through MSOME and the IMSI outcomes are needed to elucidate the role of sperm preparation techniques and morphology on IMSI outcomes.
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Neyer A, Vanderzwalmen P, Bach M, Stecher A, Spitzer D, Zech N. Sperm head vacuoles are not affected by in-vitro conditions, as analysed by a system of sperm-microcapture channels. Reprod Biomed Online 2013; 26:368-77. [DOI: 10.1016/j.rbmo.2012.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/02/2012] [Accepted: 11/27/2012] [Indexed: 11/25/2022]
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Utsuno H, Oka K, Yamamoto A, Shiozawa T. Evaluation of sperm head shape at high magnification revealed correlation of sperm DNA fragmentation with aberrant head ellipticity and angularity. Fertil Steril 2013; 99:1573-80. [PMID: 23477680 DOI: 10.1016/j.fertnstert.2013.01.100] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test for an association between DNA fragmentation and head shape at high magnification in fresh motile spermatozoa. DESIGN Observational study. SETTING Academic tertiary care center. PATIENT(S) A total of 60 men in our assisted reproductive program. INTERVENTION(S) Quantifying sperm head shape using elliptic Fourier analysis, and detecting DNA fragmentation by use of a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. MAIN OUTCOME MEASURE(S) Correlation between percentage of spermatozoa with abnormal head shape and percentage of DNA fragmentation. RESULT(S) Elliptic Fourier analysis decomposed sperm head shapes into four quantitative parameters: ellipticity, anteroposterior (AP) symmetry, lateral symmetry, and angularity. The DNA fragmentation was statistically significantly correlated with abnormal angularity, and moderately with abnormal ellipticity but not with abnormal AP symmetry or lateral symmetry. Forward stepwise multiple logistic regression analysis revealed a statistically significantly higher percentage of DNA fragmentation in spermatozoa with abnormal ellipticity and abnormal angularity than in spermatozoa with normal-shaped head (6.1% and 5.4% vs. 2.8%). Spermatozoa with large nuclear vacuoles also correlated with sperm DNA fragmentation, and had a statistically significantly higher percentage of DNA fragmentation (4.7%). CONCLUSION(S) Among the morphologic features of the sperm head, abnormal ellipticity, angularity, and large nuclear vacuoles are associated with DNA fragmentation.
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Affiliation(s)
- Hiroki Utsuno
- Department of Obstetrics and Gynecology, Shinshu University, Matsumoto, Nagano, Japan.
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