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Chapter 26 - Methods to Select Ejaculated, Epididymal, and Testicular Spermatozoa for Assisted Conception

from Section 4 - Laboratory Evaluation and Treatment of Male Infertility

Published online by Cambridge University Press:  06 December 2023

By
Sergey I. Moskovtsev ,
Michal Dviri  and
Clifford L. Librach
Edited by
Douglas T. Carrell ,
Alexander W. Pastuszak  and
James M. Hotaling
Douglas T. Carrell
Affiliation:
Utah Center for Reproductive Medicine
Alexander W. Pastuszak
Affiliation:
University of Utah
James M. Hotaling
Affiliation:
Utah Center for Reproductive Medicine
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Summary

The quality of selected spermatozoa is crucial for the success of assisted reproduction. However, selecting the “best sperm” from an ejaculate or surgically retrieved sample remains challenging. In this chapter, we have reviewed conventional, advanced, and emerging sperm selection techniques, including the most up-to-date reliable evidence-based resources, with emphasis on sperm selection methods and clinical outcomes. Current selection techniques are manual and prone to subjective judgment or experience and effort of laboratory personnel. Despite the large number of publications, the available evidences are not sufficient to support any specific sperm selection technique. The only unanimous agreement thus far is that well-designed, large-scale, sufficiently powered randomized controlled studies are required to evaluate sperm selection techniques; these may include personalized sperm selection, machine learning, and robotics strategies aimed at improving outcomes of assisted reproduction.

Keywords

IVFICSIARTsperm selectionIUI
Type
Chapter
Information
Men's Reproductive and Sexual Health Throughout the Lifespan
An Integrated Approach to Fertility, Sexual Function, and Vitality
 , pp. 204 - 209
Publisher: Cambridge University Press
Print publication year: 2023

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References

World Health Organization, ed. WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. World Health Organization; 2010.Google Scholar
Henkel, RR, Schill, W-B. Sperm preparation for ART. Reprod Biol Endocrinol. 2003;1(1):108.Google Scholar
Dai, X, Wang, Y, Cao, F, et al. Sperm enrichment from poor semen samples by double density gradient centrifugation in combination with swim-up for IVF cycles. Sci Rep. 2020;10(1):2286.Google Scholar
Oguz, Y, Guler, I, Erdem, A, et al. The effect of swim-up and gradient sperm preparation techniques on deoxyribonucleic acid (DNA) fragmentation in subfertile patients. J Assist Reprod Genet. 2018;35(6):1083–1089.CrossRefGoogle ScholarPubMed
Chen, Q, Zhao, J-Y, Xue, X, Zhu, G-X. The association between sperm DNA fragmentation and reproductive outcomes following intrauterine insemination, a meta analysis. Reprod Toxicol Elmsford N. 2019;86:50–55.Google Scholar
Sugihara, A, Van Avermaete, F, Roelant, E, Punjabi, U, De Neubourg, D. The role of sperm DNA fragmentation testing in predicting intra-uterine insemination outcome: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;244:8–15.CrossRefGoogle ScholarPubMed
Boomsma, CM, Heineman, MJ, Cohlen, BJ, Farquhar, C. Semen preparation techniques for intrauterine insemination. Cochrane Database Syst Rev. 2007;4:CD004507.Google Scholar
Huszar, G, Ozkavukcu, S, Jakab, A, Celik-Ozenci, C, Sati, GL, Cayli, S. Hyaluronic acid binding ability of human sperm reflects cellular maturity and fertilizing potential: selection of sperm for intracytoplasmic sperm injection: Curr Opin Obstet Gynecol. 2006;18(3):260–267.Google Scholar
Miller, D, Pavitt, S, Sharma, V, et al. Physiological, hyaluronan-selected intracytoplasmic sperm injection for infertility treatment (HABSelect): a parallel, two-group, randomised trial. Lancet. 2019;393(10170):416–422.Google Scholar
Lepine, S, McDowell, S, Searle, LM, Kroon, B, Glujovsky, D, Yazdani, A. Advanced sperm selection techniques for assisted reproduction. Cochrane Database Syst Rev. 2019;7:CD010461.Google Scholar
Gil, M, Sar-Shalom, V, Melendez Sivira, Y, Carreras, R, Checa, MA. Sperm selection using magnetic activated cell sorting (MACS) in assisted reproduction: a systematic review and meta-analysis. J Assist Reprod Genet. 2013;30(4):479–485.CrossRefGoogle ScholarPubMed
Romany, L, Garrido, N, Motato, Y, Aparicio, B, Remohí, J, Meseguer, M. Removal of annexin V-positive sperm cells for intracytoplasmic sperm injection in ovum donation cycles does not improve reproductive outcome: a controlled and randomized trial in unselected males. Fertil Steril. 2014;102(6):1567–1575.Google Scholar
Chan, PJ, Jacobson, JD, Corselli, JU, Patton, WC. A simple zeta method for sperm selection based on membrane charge. Fertil Steril. 2006;85(2):481–486.Google Scholar
Nasr Esfahani, MH, Deemeh, MR, Tavalaee, M, Sekhavati, MH, Gourabi, H. Zeta sperm selection improves pregnancy rate and alters sex ratio in male factor infertility patients: a double-blind, randomized clinical trial. Int J Fertil Steril. 2016;10(2):253–260.Google ScholarPubMed
Karimi, N, Mohseni Kouchesfahani, H, Nasr-Esfahani, MH, Tavalaee, M, Shahverdi, A, Choobineh, H. DGC/zeta as a new strategy to improve clinical outcome in male factor infertility patients following intracytoplasmic sperm injection: a randomized, single-blind, clinical trial. Cell J. 2020;22(1):55–59.Google ScholarPubMed
Ainsworth, C, Nixon, B, Aitken, RJ. Development of a novel electrophoretic system for the isolation of human spermatozoa. Hum Reprod. 2005;20(8):2261–2270.Google Scholar
Fleming, SD, Ilad, RS, Griffin, A-MG, et al. Prospective controlled trial of an electrophoretic method of sperm preparation for assisted reproduction: comparison with density gradient centrifugation. Hum Reprod. 2008;23(12):2646–2651.Google Scholar
Duran-Retamal, M, Morris, G, Achilli, C, et al. Live birth and miscarriage rate following intracytoplasmic morphologically selected sperm injection vs intracytoplasmic sperm injection: an updated systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2020;99(1):24–33.CrossRefGoogle ScholarPubMed
Teixeira, DM, Miyague, AH, Barbosa, MA, et al. Regular (ICSI) versus ultra-high magnification (IMSI) sperm selection for assisted reproduction. Cochrane Database Syst Rev. 2020;2:CD010167.Google ScholarPubMed
Gianaroli, L, Magli, MC, Ferraretti, AP, et al. Birefringence characteristics in sperm heads allow for the selection of reacted spermatozoa for intracytoplasmic sperm injection. Fertil Steril. 2010;93(3):807–813.Google Scholar
Vermey, BG, Chapman, MG, Cooke, S, Kilani, S. The relationship between sperm head retardance using polarized light microscopy and clinical outcomes. Reprod Biomed Online. 2015;30(1):67–73.Google Scholar
Nosrati, R, Graham, PJ, Zhang, B, et al. Microfluidics for sperm analysis and selection. Nat Rev Urol. 2017;14(12):707–730.Google Scholar
Marzano, G, Chiriacò, MS, Primiceri, E, et al. Sperm selection in assisted reproduction: a review of established methods and cutting-edge possibilities. Biotechnol Adv. 2020;40:107498.Google Scholar
Samuel, R, Son, J, Jenkins, TG, et al. Microfluidic system for rapid isolation of sperm from microdissection TESE specimens. Urology. 2020;140:70–76.CrossRefGoogle ScholarPubMed
Wang, R, Pan, W, Jin, L, et al. Artificial intelligence in reproductive medicine. Reproduction. 2019;158(4):139–154.Google Scholar
Dai, C, Zhang, Z, Huang, J, et al. Automated non-invasive measurement of single sperm’s motility and morphology. IEEE Trans Med Imaging. 2018;37(10):2257–2265.CrossRefGoogle ScholarPubMed
Zhang, Z, Dai, C, Huang, J, et al. Robotic immobilization of motile sperm for clinical intracytoplasmic sperm injection. IEEE Trans Biomed Eng. 2019;66(2):444–452.CrossRefGoogle ScholarPubMed
Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Male Reproduction and Urology. The management of obstructive azoospermia: a committee opinion. Fertil Steril. 2019;111(5):873–880.Google Scholar
Shih, K-W, Shen, P-Y, Wu, C-C, Kang, Y-N. Testicular versus percutaneous epididymal sperm aspiration for patients with obstructive azoospermia: a systematic review and meta-analysis. Transl Androl Urol. 2019;8(6):631–640.CrossRefGoogle ScholarPubMed
Practice Committee of the American Society for Reproductive Medicine. Management of nonobstructive azoospermia: a committee opinion. Fertil Steril. 2018;110(7):1239–1245.Google Scholar
Bernie, AM, Mata, DA, Ramasamy, R, Schlegel, PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015;104(5):1099–1103.Google Scholar
Deruyver, Y, Vanderschueren, D, Van der Aa, F. Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology. 2014;2(1):20–24.CrossRefGoogle ScholarPubMed
Flannigan, RK, Schlegel, PN. Microdissection testicular sperm extraction: preoperative patient optimization, surgical technique, and tissue processing. Fertil Steril. 2019;111(3):420–426.CrossRefGoogle ScholarPubMed
Corona, G, Minhas, S, Giwercman, A, et al. Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(6):733–757.Google Scholar
Ohlander, S, Hotaling, J, Kirshenbaum, E, Niederberger, C, Eisenberg, ML. Impact of fresh versus cryopreserved testicular sperm upon intracytoplasmic sperm injection pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction: a meta-analysis. Fertil Steril. 2014;101(2):344–349.CrossRefGoogle ScholarPubMed
Yu, Z, Wei, Z, Yang, J, et al. Comparison of intracytoplasmic sperm injection outcome with fresh versus frozen-thawed testicular sperm in men with nonobstructive azoospermia: a systematic review and meta-analysis. J Assist Reprod Genet. 2018;35(7):1247–1257.CrossRefGoogle ScholarPubMed
Popal, W, Nagy, ZP. Laboratory processing and intracytoplasmic sperm injection using epididymal and testicular spermatozoa: what can be done to improve outcomes? Clin Sao Paulo Braz. 2013;68(Suppl. 1):125–130.Google Scholar
Baukloh, V, German Society for Human Reproductive Biology. Retrospective multicentre study on mechanical and enzymatic preparation of fresh and cryopreserved testicular biopsies. Hum Reprod. 2002;17(7):1788–1794.Google Scholar
Kovacic, B, Vlaisavljevic, V, Reljic, M. Clinical use of pentoxifylline for activation of immotile testicular sperm before ICSI in patients with azoospermia. J Androl. 2006;27(1):45–52.Google Scholar
Ebner, T, Tews, G, Mayer, RB, et al. Pharmacological stimulation of sperm motility in frozen and thawed testicular sperm using the dimethylxanthine theophylline. Fertil Steril. 2011;96(6):1331–1336.Google Scholar
Sallam, HN, Farrag, A, Agameya, A-F, El-Garem, Y, Ezzeldin, F. The use of the modified hypo-osmotic swelling test for the selection of immotile testicular spermatozoa in patients treated with ICSI: a randomized controlled study. Hum Reprod. 2005;20(12):3435–3440.Google Scholar
Nordhoff, V, Schüring, AN, Krallmann, C, et al. Optimizing TESE-ICSI by laser-assisted selection of immotile spermatozoa and polarization microscopy for selection of oocytes. Andrology. 2013;1(1):67–74.Google Scholar
Rubino, P, Viganò, P, Luddi, A, Piomboni, P. The ICSI procedure from past to future: a systematic review of the more controversial aspects. Hum Reprod Update. 2015; 22(2):194–227.Google ScholarPubMed
Mangum, CL, Patel, DP, Jafek, AR, et al. Towards a better testicular sperm extraction: novel sperm sorting technologies for non-motile sperm extracted by microdissection TESE. Transl Androl Urol. 2020;9(2):S206–S214.Google Scholar
Esteves, SC, Roque, M, Bradley, CK, Garrido, N. Reproductive outcomes of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with high levels of DNA fragmentation in semen: systematic review and meta-analysis. Fertil Steril. 2017;108(3):456–467.Google Scholar
Ambar, RF, Agarwal, A, Majzoub, A, et al. The use of testicular sperm for intracytoplasmic sperm injection in patients with high sperm DNA damage: a systematic review. World J Mens Health. 2020;200084.Google Scholar
Awaga, HA, Bosdou, JK, Goulis, DG, et al. Testicular versus ejaculated spermatozoa for ICSI in patients without azoospermia: a systematic review. Reprod Biomed Online. 2018;37(5):573–580.Google Scholar
Kang, Y-N, Hsiao, Y-W, Chen, C-Y, Wu, C-C. Testicular sperm is superior to ejaculated sperm for ICSI in cryptozoospermia: an update systematic review and meta-analysis. Sci Rep. 2018;8(1):7874.Google Scholar
Ku, F-Y, Wu, C-C, Hsiao, Y-W, Kang, Y-N. Association of sperm source with miscarriage and take-home baby after ICSI in cryptozoospermia: a meta-analysis of testicular and ejaculated sperm. Andrology. 2018;6(6):882–889.Google Scholar

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