Clinical benefit using sperm hyaluronic acid binding technique in ICSI cycles: a systematic review and meta-analysis

Abstract

The human oocyte is surrounded by hyaluronic acid, which acts as a natural selector of spermatozoa. Human sperm that express hyaluronic acid receptors and bind to hyaluronic acid have normal shape, minimal DNA fragmentation and low frequency of chromosomal aneuploidies. Use of hyaluronic acid binding assays in intracytoplasmic sperm injection (ICSI) cycles to improve clinical outcomes has been studied, although none of these studies had sufficient statistical power. In this systematic review and meta-analysis, electronic databases were searched up to June 2015 to identify studies of ICSI cycles in which spermatozoa able to bind hyaluronic acid was selected. The main outcomes were fertilization rate and clinical pregnancy rate. Secondary outcomes included cleavage rate, embryo quality, implantation rate, spontaneous abortion and live birth rate. Seven studies and 1437 cycles were included. Use of hyaluronic acid binding sperm selection technique yielded no improvement in fertilization and pregnancy rates. A meta-analysis of all available studies showed an improvement in embryo quality and implantation rate; an analysis of prospective studies only showed an improvement in embryo quality. Evidence does not support routine use of hyaluronic acid binding assays in all ICSI cycles. Identification of patients that might benefit from this technique needs further study.

Sedimentation properties in density gradients correspond with levels of sperm DNA fragmentation, chromatin compaction and binding affinity to hyaluronic acid

“…This, and related work, suggest that spermatozoa capable of binding to hyaluronic acid have completed their maturation processes, most specifically plasma membrane remodelling and full chromatin condensation, and subsequently have an increased fertilizing capacity (Cayli et al, 2003;Huszar et al, 2003;Mokanszki et al, 2014). Different studies have suggested that hyaluronic-acid-binding improves embryo quality and development after ICSI, although all these studies were relatively small (Nasr-Esfahani et al, 2008;Parmegiani et al, 2010a;Parmegiani et al 2010b;Mokanszki et al, 2014;Beck-Fruchter et al, 2015).…”

“…The largest study to date reported a significant drop in pregnancy loss but unfortunately failed to report birth outcomes (Worrilow et al, 2013). A more recent report showed a significant improvement in live births although the lack of available raw data led to the study's exclusion from a later meta-analysis that recommended the need for better clinical trials with full data reporting (Mokanszki et al, 2014;Beck-Fruchter et al, 2015).…”

“…Several reports indicating some efficacy for the procedure have been published in relation to clinical pregnancy, pregnancy loss and, more recently, live birth rates of which the largest clinical trial to date made use of the commercially available physiological ICSI platform (Worrilow et al, 2013). See also (Nasr-Esfahani et al, 2008;Parmegiani et al, 2010a;Mokanszki et al, 2014;Beck-Fruchter et al, 2015).…”

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“…The procedure is called "physiologic ICSI", PICSI [9]. Although some reports show that PICSI has a considerably higher probability (≈5 fold) to achieve pregnancy than ICSI, a meta-analysis of all available studies concluded that although an improvement in embryo quality is provided by PICSI over ICSI, the evidence is not enough to justify the routine use of PICSI [10].…”

Spermometer: electrical characterization of single boar sperm motility

“…The ability of sperm cells to bind to hyaluronic acid is another mechanism that is reported to select mature sperm cells for ICSI (6,7). Although the bounded sperm cells do not exhibit DNA fragmentation (6,7), no improvement in pregnancy rates (PRs) and fertilization has been found using this technique as selection mechanism (8).…”