A Comprehensive Comparison of PICSI and ICSI Techniques Through a Triple-Blinded Trial: Effects on Embryo Quality, Cumulative Pregnancy Rate, and Live Birth Rate.

: Sperm selection is critical in assisted reproduction, typically relying on swim-up and centrifugation density gradients. New methods, such as PICSI (physiological intracytoplasmic sperm selection), aim to enhance outcomes by selecting mature sperm based on hyaluronic acid (HA) binding and have generated interest due to their potential impact on the clinical outcomes of patients who undergo assisted reproductive treatments. : A single-center, prospective, and triple-blinded study was conducted with 277 couples in the egg donation program. The oocytes of each recipient patient were randomly microinjected using the ICSI or PICSI technique and maintained in culture in time-lapse incubators until blastocyst formation. Biological and clinical outcomes were analyzed, including fertilization and blastocyst formation rates, embryo morphokinetics, pregnancy, miscarriage, and live birth rates, and artificial intelligence-assigned embryo quality scores. : Clinical outcomes were comparable between the two groups, but a higher pregnancy rate was observed in the PICSI group than in the ICSI group (74.04% vs. 70.87%). Although blastocyst formation rates were similar on both day 5 (D5) and day 6 of development, the proportion of good-quality embryos on D5 was higher in the PICSI group (68.27%) than in the ICSI group (63.47%) ( > 0.05). Finally, the cumulative pregnancy rate was significantly higher in the experimental group than in the control group (88% vs. 72%) after four embryo transfers ( < 0.05). : Utilizing HA to perform sperm selection during ICSI procedures does not increase live birth rates. However, it may enhance the quality of the selected sperm. This could be beneficial for patients in egg donation programs, particularly for those who have experienced repeated pregnancy loss.