IVF Laboratory, Ganin Fertility Center, Cairo, 11728, Egypt.
University of the Western Cape, Cape Town, South Africa.
J Assist Reprod Genet. 2020 Oct;37(10):2605-2613. doi: 10.1007/s10815-020-01913-4. Epub 2020 Aug 8.
To know which sperm selection technique, physiological intracytoplasmic sperm injection (PICSI) or magnetic-activated cell sorting (MACS), is better for the selection of sperm with abnormal sperm DNA fragmentation (SDF) in patients undergoing intracytoplasmic sperm injection (ICSI).
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 non-apoptotic sperm population using Annexin V magnetic beads. All pre-implantation embryogenic parameters were observed and the main outcome was the ongoing pregnancy rate.
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.
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.
NCT03398317 (retrospectively registered).
了解哪种精子选择技术，即生理胞浆内单精子注射（PICSI）或磁激活细胞分选（MACS），更适合选择精子 DNA 碎片（SDF）异常的接受胞浆内单精子注射（ICSI）的患者的精子。
一项前瞻性随机试验纳入了 413 例 TUNEL 检测 SDF 异常（>20.3%）的 ICSI 病例。当日行 ICSI 时，将至少有 100 万个总前向运动精子计数的患者随机分配至 PICSI 或 MACS 组。PICSI 依赖于透明质酸对 SDF 精子的结合，从而选择单个精子，而 MACS 使用 Annexin V 磁珠选择非凋亡精子群体。观察所有胚胎前发生参数，主要结局为持续妊娠率。
在接受 PICSI 和 MACS 治疗的患者中，研究参数包括胚胎前发生数据、着床、临床妊娠和持续妊娠率均无显著差异。同时，根据女性年龄进行的亚分析显示，MACS 组年龄小于 30 岁的女性优质囊胚、临床妊娠和持续妊娠率显著高于 PICSI 组。然而，年龄在 30-35 岁的女性中，PICSI 组的着床率（p=0.051）、临床妊娠率（p=0.078）和持续妊娠率（p=0.097）升高，但未达到统计学意义。
PICSI 和 MACS 是精子 SDF 异常患者精子选择的有效技术。然而，当女性年龄小于 30 岁时，MACS 是首选方法，而对于年龄较大的女性，PICSI 是首选方法。
NCT03398317（回顾性注册）。
