MACS-DGC sperm preparation method resulted in high-quality sperm, top-quality embryo, and higher blastocyst rate in male factor infertile couples with high DNA fragmented sperm

Personalized prediction model for miscarriage: in-depth sperm DNA fragmentation

PURPOSE

We investigated how different types of sperm DNA fragmentation (SDF) in males, in conjunction with varying levels of female reproductive potential, jointly impact ICSI outcomes.

METHODS

We retrospectively analyzed 195 couples undergoing ICSI, categorizing them by normal or poor prognosis according to POSEIDON criteria. Female factors included age, anti-Müllerian hormone (AMH), and oocyte retrieval numbers. Male factors included semen parameters, total SDF, and specific double-strand breaks (DSBs). Reproductive outcomes were followed up at different gestational stages, including clinical pregnancy, early gestation failure, live birth, and miscarriage. Risk factors were identified using univariate and multivariable logistic regression, and their predictive power was assessed via the receiver operating characteristic (ROC) curve.

RESULTS

In the normal group, female factors were primarily associated with reproductive failures. Non-pregnancy cases had lower AMH (4 ng/mL vs. 3.2 ng/mL), and miscarriage cases had fewer oocytes retrieved (15 vs. 10.5). However, the risk factor profile was distinct in poor prognosis. Male factors, including reduced sperm motility (68% vs. 54.5%), lower normal sperm morphology (5.5% vs. 2.5%), and elevated DSBs (7.5% vs. 18.8%) were linked to miscarriage. DSBs presented as the independent predictor of miscarriage risk (odds ratio: 1.19, 95% CI: 1.04-1.36), with a DSB cutoff of 19% providing 81% accuracy in predicting miscarriage.

CONCLUSION

Paternal effect is pronounced in women with poor prognosis, where elevated DSBs are linked to an increased risk of miscarriage. We propose a refined pipeline in which DSB testing is considered as initial evaluation before assisted reproductive treatments, especially for infertile couples with poor prognosis.

The Earlier Apoptosis in Human Sperm: Its Correlation with Semen Parameters and Assisted Reproduction Outcome

The combination of Syto16/7-AAD allows the detection of apoptosis at an earlier stage than that of annexin V/7-AAD. The effects of the earlier apoptosis of spermatozoa on fertilization rate and post-embryonic development have not been investigated systematically. The objective of this study is to assess the relationship between the earlier apoptosis of spermatozoa in IVF patients and seminal parameters (concentration and morphology), to assess the effect of the earlier apoptosis of spermatozoa on ART outcomes, especially with regard to clinical pregnancy. The earlier apoptosis of spermatozoa was detected by syto16/7AAD using flow cytometry (FCM) in 98 couples (98 IVF) before and after density gradient centrifugation (DGC), and its relationships with the fertilization rate, the normal fertilization rate, the cleavage rate, the good embryo rate and the cumulative clinical pregnancy rate were assessed. Meanwhile, the correlation with seminal parameters (concentration, motility and morphology) was also analyzed. The rate of the earlier apoptosis was significantly negatively correlated to sperm concentration(r = -.302, p = .003) and membrane integrity rate(r = -.862; p < .01) after DGC. There was also a positive correlation between the rate of the earlier apoptosis and sperm mortality rate (r = .225, p = .027) after DGC. A highly significantly negative correlation was found between the rate of the earlier apoptosis and outcomes in IVF patients: the fertilization rate and the normal fertilization rate decreased as the rate of the earlier apoptosis increased (r = -.271, -.288; p = .008,.004). The cumulative clinical pregnancy rate also significantly differed between patients with the earlier apoptotic rate ≥15% and <15% (57.89% vs. 81.69%, p < .01) after DGC. The earlier apoptosis of spermatozoa seems to affect fertilization, however, it does not affect the early embryo development proficiency in IVF procedures. Because of the decreased fertilization rate, the earlier apoptosis of spermatozoa can compromise the number of available embryos and good embryos, resulting in cumulative clinical pregnancy loss.

A Narrative Review on the Sperm Selection Methods in Assisted Reproductive Technology: Out with the New, the Old Is Better?

Background: Male infertility, accounting for nearly half of infertility cases worldwide, has spurred significant research into its causes, diagnosis, and treatment strategies. Genetic abnormalities, social causes, environmental exposures, lifestyle, and further health conditions are key contributors. Methods: Essential to improving the outcomes of ART is, among other things, the selection of high-quality sperm, which requires methods that assess sperm motility, morphology, DNA integrity, and oxidative stress levels. Results: Traditional techniques such as semen analysis, swim-up, and density gradient centrifugation (DGC) are still widely used, but there is ongoing discussion regarding the limitations in detecting DNA damage and oxidative stress. Advanced methods like magnetic-activated cell sorting (MACS) and microfluidic sorting have emerged as more precise tools for selecting sperm with better genetic integrity, although they face challenges in terms of their standardization, cost, and clinical adoption. Emerging technologies such as artificial intelligence (AI) and Raman spectroscopy offer the potential for more automated, accurate sperm selection, minimizing human error and variability. However, the integration of these methods into clinical practice requires further validation through large-scale studies, including assessments of their long-term safety and cost-effectiveness. Conclusions: Future research should focus on refining sperm selection techniques, tailoring them to personalized infertility approaches, and addressing the gaps in the evidence to improve ART outcomes and patient care.

Optimized sperm selection: a highly efficient device for the isolation of progressive motile sperm with low DNA fragmentation index

PURPOSE

To identify the sperm preparation procedure that selects the best sperm population for medically assisted reproduction.

METHODS

Prospective observational study comparing the effect of four different sperm selection procedures on various semen parameters. Unused raw semen after routine diagnostic analysis was split in four fractions and processed by four different methods: (1) density gradient centrifugation (DGC), (2) sperm wash (SW), (3) DGC followed by magnetic activated cell sorting (MACS), and (4) using a sperm separation device (SSD). Each fraction was analyzed for progressive motility, morphology, acrosome index (AI), and DNA fragmentation index (DFI).

RESULTS

With DGC as standard of care in intraclass correlation coefficient analysis, only SSD was in strong disagreement regarding progressive motility and DFI [0.26, 95%CI (- 0.2, 0.58), and 0.17, 95%CI (- 0.19, 0.45), respectively]. When controlling for abstinence duration, DFI was significantly lower after both MACS and SSD compared to DGC [- 0.27%, 95%CI (- 0.47, - 0.06), p = 0.01, and - 0.6%, 95%CI (- 0.80, - 0.41), p < 0.001, respectively]. Further comparisons between SSD and MACS indicate significantly less apoptotic cells [Median (IQR) 4 (5), 95%CI (4.1, - 6.8) vs Median (IQR) 5 (8), 95%CI (4.9, - 9.2), p < 0.001, respectively] and dead cells [Median (IQR) 9.5 (23.3), 95%CI (13.2, - 22.4) vs Median (IQR) 22 (28), 95%CI (23.1, - 36.8), p < 0.001, respectively] in the SSD group.

CONCLUSION

The selection of a population of highly motile spermatozoa with less damaged DNA from unprocessed semen is ideally performed with SSD. Question remains whether this method improves the embryological outcomes in the IVF laboratory.

Emerging trends in sperm selection: enhancing success rates in assisted reproduction

This comprehensive review explores the evolving landscape of sperm selection techniques within the realm of Assisted Reproductive Technology (ART). Our analysis delves into a range of methods from traditional approaches like density gradient centrifugation to advanced techniques such as Magnetic-Activated Cell Sorting (MACS) and Intracytoplasmic Morphologically Selected Sperm Injection (IMSI). We critically assess the efficacy of these methods in terms of sperm motility, morphology, DNA integrity, and other functional attributes, providing a detailed comparison of their clinical outcomes. We highlight the transition from conventional sperm selection methods, which primarily focus on physical characteristics, to more sophisticated techniques that offer a comprehensive evaluation of sperm molecular properties. This shift not only promises enhanced prediction of fertilization success but also has significant implications for improving embryo quality and increasing the chances of live birth. By synthesizing various studies and research papers, we present an in-depth analysis of the predictability of different sperm selection procedures in ART. The review also discusses the clinical applicability of these methods, emphasizing their potential in shaping the future of assisted reproduction. Our findings suggest that the integration of advanced sperm selection strategies in ART could lead to more cost-effective treatments with reduced duration and higher success rates. This review aims to provide clinicians and researchers in reproductive medicine with comprehensive insights into the current state and future prospects of sperm selection technologies in ART.

The Use of Non-Apoptotic Sperm Selected by Magnetic Activated Cell Sorting (MACS) to Enhance Reproductive Outcomes: What the Evidence Says

Sperm selection of the most competent sperm is a promising way to enhance reproductive outcomes. Apoptosis is the programmed cell death process to maintain tissue homeostasis, and MACS sperm selection of non-apoptotic cells enables the removal of apoptotic sperm from an ejaculate, thus leaving the non-apoptotic available to be microinjected, but given the associated costs of adding these sperm selection steps to the routine practice, there is a need for a careful examination of the literature available to answer questions such as who can benefit from this MACS, how significant this improvement is, and how robust the evidence and data available supporting this choice are. Thus, the aim of this narrative review was to objectively evaluate the available evidence regarding the potential benefits of the use of MACS. From the literature, there are controversial results since its implementation as an in vitro fertilization add-on, and this may be explained in part by the low quality of the evidence available, wrong designs, or even inadequate statistical analyses. We concluded that the benefits of adding MACS are unclear, and further methodologically sound research on specific populations is much needed before offering it clinically.