The Use of Non-Apoptotic Sperm Selected by Magnetic Activated Cell Sorting (MACS) to Enhance Reproductive Outcomes: What the Evidence Says

Abstract

Sperm selection of the most competent sperm is a promising way to enhance reproductive outcomes. Apoptosis is the programmed cell death process to maintain tissue homeostasis, and MACS sperm selection of non-apoptotic cells enables the removal of apoptotic sperm from an ejaculate, thus leaving the non-apoptotic available to be microinjected, but given the associated costs of adding these sperm selection steps to the routine practice, there is a need for a careful examination of the literature available to answer questions such as who can benefit from this MACS, how significant this improvement is, and how robust the evidence and data available supporting this choice are. Thus, the aim of this narrative review was to objectively evaluate the available evidence regarding the potential benefits of the use of MACS. From the literature, there are controversial results since its implementation as an in vitro fertilization add-on, and this may be explained in part by the low quality of the evidence available, wrong designs, or even inadequate statistical analyses. We concluded that the benefits of adding MACS are unclear, and further methodologically sound research on specific populations is much needed before offering it clinically.

An Alternative Application of Magnetic-Activated Cell Sorting: CD45 and CD235a Based Purification of Semen and Testicular Tissue Samples

“…3 of 13 ICSI failures/miscarriages with an unknown female cause with higher DNA-fragmentation by the male partner, though its application lacks any high level evidence, therefore its application should be consulted individually with each couple [22]. Since the quality of the current evidence is very low, the true clinical effects of the method on ART outcomes are still a debate and large randomized controlled studies are missing.…”

“…One of the latter is the externalisation of phosphatidylserine (PS), which is a phospholipid located normally on the inner surface of the cell membrane [21]. Unfortunately, spermatozoa can carry this and other early signs of apoptosis without significant impact on morphology or motility, thus it can escape further phases of programmed cell death and fertilise the oocyte [22]. In a study by Hichri et al showed that distinct apoptotic alterations (the ratio of activated caspases, externalized PS, DNA-fragmentation) are reliable predictors of ART outcomes independently of conventional sperm parameters, DNA-fragmentation with best predictive value [23].…”

“…Many studies proved that MACS effectively reduces DNA-fragmentation [25][26][27], yielding spermatozoa with higher DNA integrity, meaning higher quality for ART. The technique is frequently suggested to couples with more than two ICSI failures/miscarriages with an unknown female cause with higher DNA-fragmentation by the male partner, though its application lacks any high level evidence, therefore its application should be consulted individually with each couple [22].…”