A prospective randomized study to evaluate the effect of hyaluronic acid sperm selection on the intracytoplasmic sperm injection outcome of patients with unexplained infertility having normal semen parameters
- 382 Downloads
Sperm quality plays an important role in determining embryo development and intracytoplasmic sperm injection (ICSI) outcome. Selection of competent sperm based on its ability to bind to hyaluronic acid (HA) has been suggested as one of the methods to assess sperm quality. The aim of the present study was to examine whether injection of HA bound sperm helps in improving outcome in patients undergoing ICSI with unexplained infertility having normal semen parameters.
Patients with unexplained infertility having normal semen parameters in accordance with WHO 2010 criterion, undergoing their first IVF-ICSI cycle were enrolled during the course of the study.156 patients were prospectively randomized after oocyte retrieval and were assigned to either the ICSI group, where sperm selection for injection was based on visual assessment, or the PICSI group, where sperm were selected based on their ability to bind to HA. Only fresh embryo transfers were included in the analysis.
There was no difference in the fertilization rates, number of top quality embryos and clinical pregnancy rates between the ICSI and PICSI groups (65.7 % vs 64.7 %; 45.8 % vs 43.6 % and 35 % vs 35.2 % respectively). However, a higher pregnancy loss rate was observed in the ICSI group (25 % vs 12 %; P = 0.227) as compared to the PICSI group, but the difference was not statistically significant. Implantation rates were 22.03 % and 18.84 % in the PICSI and ICSI groups respectively. There were 22 (31 %) live births in the PICSI group and 21(26.3 %) live births in the ICSI group.
Patients with unexplained infertility having normal semen parameters may constitute a patient group which does not benefit from this sperm selection method. A larger study may be necessary to establish a relationship between PICSI and pregnancy loss rate in patients undergoing IVF with unexplained infertility.
KeywordsHyaluronic acid binding Sperm selection PICSI Unexplained infertility Pregnancy loss rate
The authors would like to express their gratitude to Shweta Gupta and Ruma Satwik for giving valuable inputs in the study, the team of embryologists working in the IVF laboratory and all patients who participated in the study.
Conflict of interest
The authors declare they have no conflict of interest.
- 1.Huszar G. Hyaluronic acid binding-mediated sperm selection for ICSI. In: Gardner DK, Weissman A, Howles CM, Shoham Z, editors. Textbook of assisted reproductive techniques. London; 2011. pp.122–34.Google Scholar
- 7.Parmegiani L, Cognigni GE, Bernardi S, Troilo E, Ciampaglia W, Filicori M. “Physiologic ICSI”: Hyaluronic acid (HA) favors selection of spermatozoa without DNA fragmentation and with normal nucleus, resulting in improvement of embryo quality. Fertil Steril. 2010 Feb;93(2):598–604.Google Scholar
- 10.Ménézo Y, Nicollet B. Replacement of PVP by hyaluronate (SpermSlow™) in ICSI—Impact on outcome. 2004 Abstract of 18th World Congress on Fertility and Sterility IFFS.Google Scholar
- 11.Worrilow KC, Huynh T, Bower JB, Anderson AR, Schillings W, Crain JL. PICSI VS ICSI: statistically significant improvement in clinical outcomes in 240 in vitro fertilization (IVF) patients. Fertil Steril 2007; 88 Supp 1: s37.Google Scholar
- 13.Castillo-Baso J, Garcia-Villafaña G, Santos-Haliscak R, Diaz P, Sepluveda-Gonzalez J, Hernandez-Ayup S. Embryo quality and reproductive outcomes of spermatozoa selected by physiologic-icsi or conventional icsi in patients with kruger <4% and >4% normo-morphology. Fertil Steril. 2011;96:S159.CrossRefGoogle Scholar
- 14.Worrilow KC, Eid S, Woodhouse D, Witmyer J, Khoury C, Liebermann J. Increased clinical pregnancy rates (CPR) and statistically significant decrease in loss rates using hyaluronan in sperm selection: prospective, multi-center, double-blind, randomized clinical trial. Fertil Steril. 2011;96:S179.CrossRefGoogle Scholar
- 15.Worrilow KC, Eid S, Woodhouse D, Perloe M, Smith S, Witmyer J, et al. Use of hyaluronan in the selection of sperm for intracytoplasmic sperm injection (ICSI): Significant improvement in clinical outcomes–multicenter, double-blinded and randomized controlled trial. Hum Reprod. 2013;28(2):306–14.PubMedCrossRefGoogle Scholar
- 16.WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010.Google Scholar
- 17.Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011;26:1270–1283Google Scholar
- 18.Choe SA, Tae JC, Shin MY, Kim HJ, Kim CH, Lee JY, et al. Application of sperm selection using hyaluronic acid binding in intracytoplasmic sperm injection cycles: A sibling oocyte study. J Korean Med Sci. 2012 December;27(12):1569–73.Google Scholar
- 22.Pfeifer S, Fritz M, Goldberg J, McClure RD, Lobo R, Thomas M, et al. Intracytoplasmic sperm injection (ICSI) for non male factor infertility: A committee opinion. Fertil Steril. 2012;98(6):1395–9.Google Scholar