The pellet swim-up is the best technique for sperm preparation during in vitro fertilization procedures

Abstract

Purpose The aim of this study was to investigate the most suitable sperm preparation technique to apply in order to obtain a spermatozoon population with minimal DNA damage during in vitro fertilization procedures. We compared four preparation techniques: direct swim-up (DSU), pellet swimup (PSU), density gradient (DG), and density gradient followed by swim-up (DG-SU), evaluating the effects of each technique on the DNA damage rate, evaluated by DNA fragmentation index of the spermatozoa obtained. Methods In this observational study, 98 semen samples from couples undergoing IVF/ICSI cycles were included. Data were collected between April and November 2014 at the ANDROS Day Surgery Clinic, Palermo, Italy. Result(s) The percentages of DNA fragmentation were 18.30 ± 10.8 in raw samples, 6.6 ± 5.7 after DSU, 4.2 ± 3.8 after PSU, 12.9 ± 9.9 after DG, and 3.7 ± 4.0 after DG-SU respectively. Compared to the raw evaluation, all the preparation techniques significantly decreased the total rate of the DNA fragmentation (DSU Z = −8.60, P < 0.008; PSU Z = −8.54, P < 0.008; DG Z = −6.42, P < 0.008, and DG-SU Z = −8.60, P < 0.008, respectively). Comparing them, spermatozoa with intact DNA after PSU and DG-SU were significantly higher than after DSU (Z = −7.12, P < 0.008; Z = −6.59, P < 0.008, respectively) and after DG (Z = −8.41, P < 0.008; Z = −8.60, P < 0.008, respectively). The difference between PSU and DG-SU was not significant (Z = −2.21, P = 0.03). Conclusion(s) There are, above all, two techniques of sperm preparation which allow for the recovery of spermatozoa with the lowest DNA fragmentation rate. Furthermore, given low costs and reduced time, we believe that PSU is the best option in the treatment of semen samples during IVF/ICSI.

Semen preparation methods and sperm telomere length: density gradient centrifugation versus the swim up procedure

“…Amiri and colleagues found that the number of DNA-fragmented spermatozoa in samples prepared by the SU method was larger than those in samples processed with the DGC approach32. However, some studies have found that the mean DNA fragmentation in samples processed by DGC was higher than in samples collected with the SU method3334. Telomeres are fundamental for genome integrity17.…”

Effect of the sexual abstinence period recommended by the World Health Organization on clinical outcomes of fresh embryo transfer cycles with normal ovarian response after intracytoplasmic sperm injection

“…The commonly used methods for sperm preparation in routine ART are the swim‐up method and density gradient centrifugation. These methods aid in the selection of an available spermatozoon with a normal morphology and help decrease the ratio of spermatozoa with DNA fragmentation (Volpes et al., ). Additionally, spermatozoa with DNA fragmentation could be reduced by recurrent ejaculation (every 24 hr for 4 days) combined with using density gradient centrifugation, which would lead to a significant increase in pregnancy rates with ICSI using such spermatozoa (Sánchez‐Martín et al., ).…”

Direct swim-up without centrifugation is a more recommended technique for sperm preparation in conventional IVF cycles

“…However, several studies reported that a combination technique of density-gradient centrifugation and swim-up (DGC-SU) was more effective in enriching sperm cells with normal morphology and eliminating sperm cells with DNA fragmentation than DGC technique alone [4][5][6][7]. Given this, the DGC-SU technique is more widely used in the field of ART work concerning sperm preparation compared to DGC technique alone at the present time in China.…”

“…This finding suggests that density-gradient centrifugation should be avoided during sperm preparation [19]. In addition, the DGC-SU technique requires operators to transfer sperm sample among several tubes, thereby increasing the potential risk of mismatches [5,[20][21]. These limitations, in concert, suggested that the DGC-SU was not optimal technique for sperm preparation for IVF and ICSI treatments.…”