Sperm Selection Technology in ART

Abstract

Intracytoplasmic sperm injection (ICSI) is a commonly used in vitro fertilization technique. Selection of sperm for injection is currently done using subjective assessment of morphology, which may not accurately identify the best-quality sperm. Hyaluronic acid receptors on sperm plasma membranes are a marker of maturity, and sperms which are capable of binding immobilized hyaluronic acid in vitro are of higher quality. This can be used as an advanced sperm selection technique to choose sperm for ICSI, termed physiological ICSI (PICSI). Several studies reported improved fertility treatment outcomes when using PICSI compared with conventional ICSI; however, the majority of studies are underpowered. Recently, a large, multicenter, randomized controlled trial, known as the Hyaluronic Acid Binding Sperm Selection (HABSelect) trial, found a significant reduction in miscarriage rates with PICSI, but no significant effect on live birth rate. There are still many avenues through which PICSI may provide an advantage, subject to confirmation by future research, such as improved long-term health of offspring. Other advanced sperm selection techniques include intracytoplasmic morphologically selected sperm injection, magnetic-activated cell sorting, and Zeta potential sperm selection; however, the most recent Cochrane review concluded that there is currently insufficient evidence to ascertain whether these techniques improve clinical outcomes, such as live birth rates.

Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles

“…Indeed, the current application of ICSI is not justified by the minimal increase of live birth rate obtained at disproportionately increased costs. Our result confirms the previous demonstration of the relevant role of sperm morphology in ART outcomes 62–64 . The impact of teratozoospermia on IVF/ICSI offspring was inconclusive so far 35 .…”

“…Our result confirms the previous demonstration of the relevant role of sperm morphology in ART outcomes. [62][63][64] The impact of teratozoospermia on IVF/ICSI offspring was inconclusive so far. 35 Recently, Zhou et al evaluated the influence of teratozoospermia on pregnancy outcome and newborn status after IVF and ICSI, detecting a limited predictive value for pregnancy outcomes and little impact on the resulting offspring.…”

“…Our result confirms the previous demonstration of the relevant role of sperm morphology in ART outcomes. 62 , 63 , 64 The impact of teratozoospermia on IVF/ICSI offspring was inconclusive so far. 35 Recently, Zhou et al.…”

Microfluidic devices employing chemo‐ and thermotaxis for sperm selection can improve sperm parameters and function in patients with high DNA fragmentation

“…Hyaluronic acid's activity includes the opening of L‐type Ca 2+ channels in the sperm membrane. In human sperm cell membranes, hyaluronic acid receptors (CD44) have been found (Martin & Woodland, 2021). Hyaluronan‐specific receptor (CD44) permits mature and normal morphology spermatozoa to bind to hyaluronan (Huszar et al, 2003; Martin & Woodland, 2021).…”

“…In human sperm cell membranes, hyaluronic acid receptors (CD44) have been found (Martin & Woodland, 2021). Hyaluronan‐specific receptor (CD44) permits mature and normal morphology spermatozoa to bind to hyaluronan (Huszar et al, 2003; Martin & Woodland, 2021). The activation of hyaluronic acid receptors increases intracellular protein phosphorylation, tyrosine‐specific phosphorylation, receptor autophosphorylation, and the formation of inositol trisphosphate, as well as the fast increase in intracellular Ca 2+ .…”