A prospective randomized study to evaluate the effect of hyaluronic acid sperm selection on the intracytoplasmic sperm injection outcome of patients with unexplained infertility having normal semen parameters

Abstract

Purpose Sperm quality plays an important role in determining embryo development and intracytoplasmic sperm injection (ICSI) outcome. Selection of competent sperm based on its ability to bind to hyaluronic acid (HA) has been suggested as one of the methods to assess sperm quality. The aim of the present study was to examine whether injection of HA bound sperm helps in improving outcome in patients undergoing ICSI with unexplained infertility having normal semen parameters. Methods Patients with unexplained infertility having normal semen parameters in accordance with WHO 2010 criterion, undergoing their first IVF-ICSI cycle were enrolled during the course of the study.156 patients were prospectively randomized after oocyte retrieval and were assigned to either the ICSI group, where sperm selection for injection was based on visual assessment, or the PICSI group, where sperm were selected based on their ability to bind to HA. Only fresh embryo transfers were included in the analysis. Results There was no difference in the fertilization rates, number of top quality embryos and clinical pregnancy rates between the ICSI and PICSI groups (65.7 % vs 64.7 %; 45.8 % vs 43.6 % and 35 % vs 35.2 % respectively). However, a higher pregnancy loss rate was observed in the ICSI group (25 % vs 12 %; P =0.227) as compared to the PICSI group, but the difference was not statistically significant. Implantation rates were 22.03 % and 18.84 % in the PICSI and ICSI groups respectively. There were 22 (31 %) live births in the PICSI group and 21(26.3 %) live births in the ICSI group. Conclusions Patients with unexplained infertility having normal semen parameters may constitute a patient group which does not benefit from this sperm selection method. A larger study may be necessary to establish a relationship between PICSI and pregnancy loss rate in patients undergoing IVF with unexplained infertility.

Is sperm hyaluronic acid binding ability predictive for clinical success of intracytoplasmic sperm injection: PICSI vs. ICSI?

“…Another recent study did not find any differences in FR, IR, and CPR between ICSI and PICSI patients. The only benefit of injecting HA selected sperm was a lower PLR which consequently translated to a higher LBR, both of which were not statistically significant [Majumdar and Majumdar 2013].…”

Hyaluronan-binding system for sperm selection enhances pregnancy rates in ICSI cycles associated with male factor infertility

“…For instance, in the study by Majumdar & Majumdar (2013), the morphologic selection and the HA system techniques were compared in relation to patients with infertility without apparent reason and without associated male factors. Indeed, the results did not show significant differences, but demonstrated a tendency in the reduction of abortion rates in the cases that used the HA system for sperm selection.…”

Annexin V-MACS in infertile couples as method for separation of sperm without DNA fragmentation

“…Favoring selection of spermatozoa with intact DNA and normal nucleus, HA may be another alternative to optimize ICSI outcome, in fact some studies have shown significant differences (Parmegiani, 2010) while others did not find differences in clinical pregnancy rate or embryo quality (Ménézo & Nicollet, 2004;Majumdar & Majumdar, 2013). We decided to compare the two new methods for sperm selection, patients of PICSI group show clinical pregnancy rate benefits compared to ICSI group (40.4% vs 27.3 %, respectively), but its benefit was inferior to the MACS group (58.1%).…”