Physiological intracytoplasmic sperm injection does not improve the quality of embryos: A cross-sectional investigation on sibling oocytes

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.

Does Physiological Intracytoplasmic Sperm Injection Improve Outcome in Men with Abnormal Semen Parameters: A Retrospective Cohort Study

Background

As the male factor in infertility is on rising trend, we need a promising tool for sperm selection to improve the embryo development.

Aim

The present study compares the embryological and clinical parameters between physiological intracytoplasmic sperm injection (PICSI) and conventional intracytoplasmic sperm injection (ICSI) in abnormal semen parameters.

Settings and Design

This was a retrospective cohort study.

Materials and Methods

This study was conducted over the duration of 9 months from April to December 2023. One hundred and four patients, who matched the inclusion and exclusion criteria, were enrolled in the study. The adjusted blastulation rate was evaluated as the primary outcome, and the secondary outcomes studied were fertilisation rate, good-quality cleavage stage embryo rate, clinical pregnancy and miscarriage rate.

Statistical Analysis Used

The outcome measures were calculated using independent Student's t-test, and P < 0.5 was considered statistically significant.

Results

The 104 enrolled patients were divided into two groups. In the study population (n = 51), PICSI was used for sperm selection and the controls (n = 53) used conventional ICSI. The adjusted blastulation rate was statistically significant higher in the PICSI group (43.7%) as compared to the controls (34.2%) (P = 0.022). The fertilisation and cleavage rates were not statistically different amongst the groups. The pregnancy rate (37.2% vs. 32%, P = 0.027) and miscarriage rate (5.3% vs. 11.7%, P = 0.005) were statistically better in the PICSI group.

Conclusion

PICSI may improve treatment outcomes in couples undergoing assisted reproduction for male factor infertility. However, larger randomised controlled trials are needed for validating the current study findings.

Application of Physiological Sperm Selection in Assisted Reproductive Technology (ART) for Patients With Diabetes Mellitus: A Case Report

This case report revolves around a 35-year-old woman and her 39-year-old husband, who have been married for 10 years and were seeking treatment for their secondary infertility. The husband had been diagnosed with diabetes mellitus (DM) for the past seven years and had been on continued medication. Both partners underwent medical evaluations, and the husband was found to have normozoospermia. The wife had a normal ovarian reserve but was still facing difficulties in conception. Previous medical history showed that the husband's DM had been treated with metformin, and the woman had a history of unsuccessful in vitro fertilization (IVF) cycles and one miscarriage upon investigation. Our initial treatment attempt had failed, and upon assessment of the semen, it revealed a significantly increased sperm DNA fragmentation index, leading us to consider physiological intracytoplasmic sperm injection (PICSI). The couple then opted for a rescheduled ovum pick-up with PICSI over traditional ICS. PICSI involves selecting mature sperm with hyaluronic acid affinity, aiming to avoid immature, morphologically defective spermatozoa during microinjection. The couple then followed up for treatments; the husband continued with diabetes treatment, and the woman was advised to take progesterone supplements to ensure optimum uterine thickness. The PICSI procedure was followed by a successful embryo transfer, which subsequently led to a positive clinical pregnancy. This report highlights the importance of utilizing advanced technologies like PICSI in infertility cases after considering factors such as sperm quality to enhance the chances of a successful clinical pregnancy.