PICSI vs. MACS for abnormal sperm DNA fragmentation ICSI cases: a prospective randomized trial

Abstract

Purpose To know which sperm selection technique, physiological intracytoplasmic sperm injection (PICSI) or magneticactivated cell sorting (MACS), is better for the selection of sperm with abnormal sperm DNA fragmentation (SDF) in patients undergoing intracytoplasmic sperm injection (ICSI). Methods A prospective randomized trial included 413 ICSI cases with abnormal SDF (> 20.3%) by TUNEL assay. Patients with at least 1 million total progressive motile sperm count were randomized to PICSI or MACS groups on the day of ICSI. PICSI depends on the hyaluronan binding of better SDF sperm where individual sperm was selected, while MACS selects nonapoptotic sperm population using Annexin V magnetic beads. All pre-implantation embryogenic parameters were observed and the main outcome was the ongoing pregnancy rate. Results There were no significant differences between patients allocated to PICSI and MACS in the studied parameters including pre-implantation embryological data, implantation, clinical pregnancy, and ongoing pregnancy rates. Meanwhile, sub-analysis according to the female age has shown that female patients with less than 30 years of age in the MACS group had significantly higher good-quality blastocyst, clinical pregnancy, and ongoing pregnancy rates than the PICSI group. However, the higher implantation (p = 0.051), clinical pregnancy (p = 0.078), and ongoing pregnancy (p = 0.097) rates observed in females between 30 and 35 years of age in the PICSI group did not reach significance level. Conclusions PICSI and MACS are efficient techniques for sperm selection in cases with abnormal sperm DNA fragmentation. However, MACS is preferred when the females are younger than 30 years, while PICSI is preferred in older females. Clinical trial registration number NCT03398317 (retrospectively registered)

Sperm Selection Technology in ART

“…Subgroup analysis showed that female patients younger than 30 years in the MACS group (n ¼ 86) had significantly higher clinical pregnancy (73.9 vs. 58.3%, p ¼ 0.03) and ongoing pregnancy rates (69.5 vs. 51.3%, p ¼ 0.015) than PICSI (n ¼ 83). 48 Contrastingly, female patients between 30 and 35 years of age in the PICSI group (n ¼ 110) showed a nonsignificant increase in implantation (33.3 vs. 46%, p ¼ 0.05), clinical pregnancy (53.2 vs. 64.7%, p ¼ 0.07), and ongoing pregnancy rates (47.8 vs. 58.8%, p ¼ 0.09) compared with MACS (n ¼ 117). The most recent Cochrane study has concluded that current evidence from randomized controlled trials is low quality, and no conclusions can be drawn as to whether MACS improves live birth, clinical pregnancy, or miscarriage rates.…”

Sperm DNA integrity and male infertility: a narrative review and guide for the reproductive physicians

“…❖ Physiologic ICSI (P-ICSI): uses hyaluronic acid binding to choose mature sperm which were found to contain significantly lower SDF compared to initial unprocessed sperm (5.3% vs. 16.5%; P<0.001) ( 129 ). When compared to MACS, no significant differences were found for implantation, clinical pregnancy, and ongoing pregnancy rates overall, but when stratified for female age, outcomes were better when P-ICSI was used for women older than 30 versus MACS, although not statistically significant ( 130 ).…”

Evaluation of Sperm Selection Technique Using Hyaluronic Acid Binding During Icsi; a Randomized Controlled Trial

“…When comparing PICSI vs. magnetic-activated cell sorting (MACS) for abnormal sperm DNA fragmentation ICSI cases Hasanen et al 2018 (23), in their clincal trial found that PICSI and MACS are efficient techniques for sperm selection in cases with abnormal sperm DNA fragmentation. However, MACS is preferred when the females are younger than 30 years, while PICSI is preferred in older females.…”