The elimination of apoptotic sperm in IVF procedures and its effect on pregnancy rate

Abstract

Objective: To identify the effect of apoptotic sperm elimination with MACS in patients that require IVF. Methods: An experimental, cross-sectional, descriptive, prospective and non-blinded study of diagnostic tests performed in patients who required IVF and ICSI from July 2011 to July 2012. Ninety-two couples participated according to the treatment administered to the semen sample; in the control group: the samples were subjected only to density gradients before ICSI, in the study group: the same procedure was performed plus the addition of the MACS technique. Comparing the groups, we assessed the fertilization, division, viable embryos and clinical pregnancy rates in all cases. Results: We found significant differences when using MACS technique in sperm parameters. We found no differences between the total samples of the control and study groups. When separating the own and donated eggs in each group, we found an improvement in the fertilization rates ( p <0.001) of the own eggs. In both groups, the handling of donated eggs lead to a significant improvement in the immunological pregnancy test (IPT) and fetal heart rate (FHR) results. Only in the donated eggs group, where MACS was applied, could we see that all cases with positive IPT had a fetal heart rate, which shows a significant difference ( p <0.002) when compared with the control group, where the percentage decreased abruptly. Conclusions: This study demonstrates the effectiveness of the use of annexins (MACS) in eliminating apoptotic sperm, and when the obtained sperm is applied to good-quality eggs.

A Biomimetic Microfluidic Selection Platform Providing Improved Sperm Quality Metrics Compared to Swim-Up

“…High levels of early-stage sperm apoptosis have also been suggested to play a role in recurrent pregnancy loss 23 . It has also been demonstrated that the use of apoptotic sperm removal plays a signi cant role in improving fertilization rate and rates of clinical pregnancies when combined with the use of good quality donor oocytes 20 . The value of removing apoptotic sperm resides in the fact that they may still be able to fertilize an oocyte, particularly during an ICSI treatment, as they often present without morphological abnormalities.…”

“…One such marker is the externalized membrane protein phosphatidylserine, which is an indicator or early-stage apoptosis in sperm. It has already been proven that the proportion of early apoptotic sperm cells in raw semen can reach over 20% 19 , and that eliminating apoptotic sperm using annexins correlates to an improvement in embryo quality 20 and a further decrease in sperm DNA fragmentation which is directly correlated to apoptosis 56 . High levels of early-stage sperm apoptosis have also been suggested to play a role in recurrent pregnancy loss 23 .…”

“…Therefore, it stands to reason that using a combination of mechanisms for sperm selection may provide more fecund sperm, particularly for ICSI. One such mechanism is the tagging and removal of apoptotic sperm using Annexin V. The proportion of early apoptotic sperm cells in raw semen has been shown to reach over 20% 19 , and it has been reported that eliminating apoptotic sperm using annexins correlated to an improvement in embryo quality 20 . Annexin A5 (AAV) is an example of one such apoptotic marker that binds to phosphatidylserine externalized in apoptotic cells 20 .…”

“…One such mechanism is the tagging and removal of apoptotic sperm using Annexin V. The proportion of early apoptotic sperm cells in raw semen has been shown to reach over 20% 19 , and it has been reported that eliminating apoptotic sperm using annexins correlated to an improvement in embryo quality 20 . Annexin A5 (AAV) is an example of one such apoptotic marker that binds to phosphatidylserine externalized in apoptotic cells 20 . This action reduces the impact of cells undergoing both spontaneous and testicular induced cell death via apoptosis during conception.…”

Sperm quality metrics were improved by a biomimetic microfluidic selection platform compared to swim-up methods

“…Therefore, using a combination of mechanisms for sperm selection may provide more fecund sperm, particularly for ICSI. One mechanism involves the tagging and removal of apoptotic sperm using Annexin V. The proportion of early apoptotic sperm cells in raw semen has been shown to reach over 20% 21 , and it has been reported that eliminating apoptotic sperm using annexins correlated with an improvement in embryo quality 22 . Annexin A5 (AAV) is an example of one such apoptotic marker that binds to phosphatidylserine externalized in apoptotic cells 22 .…”