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

Abstract

Although intracytoplasmic sperm injection (ICSI) is now a widely-used technique, it is still of interest to improve our knowledge as to which is the best spermatozoon to be selected for ICSI. Infertile men have increased risks of producing aneuploid spermatozoa. Using hyaluronic acid (HA)-binding sperm selection may reduce the genetic risks such as chromosomal aberrations of offspring. In the present study we examined the clinical success of ICSI with HA-selected sperm ('physiologic' ICSI, PICSI) compared to conventional ICSI, as well as the necessity to differentiate patients according to the initial HA-binding assay result (HBA score) and whether the sperm concentration or HBA score can provide additional information. We observed a significantly higher fertilization rate (FR) of the PICSI group with 460% HBA, implantation rate (IR) of the PICSI group with 60% HBA, and clinical pregnanacy rate (CPR) in every PICSI group compared to the ICSI groups (p50.01). We also observed a significantly higher life birth rate (LBR) in the PICSI group with 60% HBA compared to ICSI patients with 60% HBA (p50.001). The pregnancy loss rate (PLR) was significanly lower in PICSI patients compared to the ICSI group (p50.0001). The FR, IR, CPR, and LBR of the PICSI group with 550% HBA were significantly higher and the PLR was lower than in the ICSI group with 550% HBA (p50.01). A statistically significant correlation was found between the sperm concentration and the HA-binding capacity (r ¼ 0.62, p50.001). We found a closer relationship between HBA score and FR (r ¼ 0.53, NS) than between sperm concentration and FR (r ¼ 0.14, NS). HBA could be considered for sperm selection prior to ICSI because of its success and apparant ability to reduce genetic complications. However, this must be extended to a larger study.

Prediction of DNA Integrity from Morphological Parameters Using a Single‐Sperm DNA Fragmentation Index Assay

“…The chemical modification of glass with HA was confirmed by fluorescence imaging of Fluorescein isothiocyanate (FITC) labeled HA and by observing the change of hydrophobicity of glass ( Figure S1, Supporting Information). [28][29][30] Unlike the physical absorption of HA hydrogel on a plastic substrate in PICSI dishes, [31] we functionalized the glass surface with HA using permanent chemical bonding. After sperm settled down on the HA glass, mature and live sperm were bound to HA by the CD44 cell receptor, [24][25][26][27] while nonmotile sperm simply settled on the HA glass.…”

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

“…Eight publications were excluded as no full text article was published (Barak et al, 1999;Kim et al, 2014;Menezo et al, 2010;Sanchez et al, 2005;Saymé et al, 2013;Worrilow et al, 2005Worrilow et al, , 2006Worrilow et al, , 2007. Two studies were excluded because the raw data were not presented (Mokánszki et al, 2014;Nasr-Esfahani et al, 2008). An attempt was made to contact investigators via email to obtain missing information but no replies were received.…”

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

“…A potential link between hyaluronic-acid-binding (which can be considered a surrogate for sperm binding to the endocervical mucus and the hyaluronan-rich cumulus oopherous complex) and spermatozoal viability, was established in the 1990s (Vandevoort et al 1997;Cayli et al 2003). 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).…”