Andrology Laboratory and Reproductive Tissue Bank, The Toronto Institute for Reproductive Medicine (ReproMed), 56 Aberfoyle Crescent, Toronto, ON, Canada M8X 2W4.
Hum Reprod Update. 2011 Nov-Dec;17(6):719-33. doi: 10.1093/humupd/dmr032. Epub 2011 Aug 25.
Current routine semen preparation techniques do not inclusively target all intrinsic sperm characteristics that may impact the fertilization potential. In order to address these characteristics, several methods have been recently developed and applied to sperm selection. The objective of this study was to systematically review the literature describing these advanced sperm selection methods focusing on their anticipated benefits on sperm quality and assisted reproductive technique (ART) outcome.
Systematic literature review was conducted by means of a Medline literature search. Sperm quality parameters assessed included: motility, morphology, viability, DNA integrity, apoptosis and maturity. ART outcomes assessed included: fertilization, embryo quality, pregnancy, abortion and live birth rates.
A total of 44 studies were identified describing four advanced sperm selection methods based on: (i) surface charge (electrophoresis and zeta potential), (ii) apoptosis (magnetic cell sorting and glass wool), (iii) membrane maturity (hyaluronic acid binding) and (iv) ultramorphology (high magnification). Selection of high-quality sperm including improvements in DNA integrity, resulted from the application of these methods. Fertilization and pregnancy rates showed improvement following some of the advanced sperm selection techniques.
While some of the advanced sperm selection methods are of value in specific clinical ART settings, others are in need of further evaluation. More clinical studies on safety and efficacy are needed before the implementation of advanced sperm selection methods could be universally recommended in ART.
目前的常规精液准备技术并不能全面针对所有可能影响受精能力的内在精子特征。为了解决这些特征，最近已经开发并应用了几种方法来进行精子选择。本研究的目的是系统地回顾描述这些先进的精子选择方法的文献，重点关注它们对精子质量和辅助生殖技术（ART）结果的预期益处。
通过 Medline 文献检索进行系统的文献回顾。评估的精子质量参数包括：活力、形态、活力、DNA 完整性、凋亡和成熟度。评估的 ART 结果包括：受精、胚胎质量、妊娠、流产和活产率。
共确定了 44 项描述了四种基于以下方法的先进精子选择方法的研究：（i）表面电荷（电泳和 zeta 电位）、（ii）凋亡（磁细胞分选和玻璃棉）、（iii）膜成熟（透明质酸结合）和（iv）超形态学（高倍放大）。这些方法的应用使精子质量得到改善，包括 DNA 完整性的提高。一些先进的精子选择技术可以提高受精率和妊娠率。
虽然一些先进的精子选择方法在特定的临床 ART 环境中具有价值，但其他方法还需要进一步评估。在普遍推荐在 ART 中应用先进的精子选择方法之前，需要进行更多关于安全性和有效性的临床研究。
