O-14: New Era in Sperm Selection for ICSIProcedure

Background: Intra-cytoplasmic sperm insemination, the ICSI, is considered as the one most routine treatment of male infertility. Although the genetic inheritance of an individual is based on the genetic contribution from both the oocyte and sperm, considering the fact that ICSI by passes all the barriers to natural fertilization much emphasis was given to oocyte quality to improve the ICSI outcomes. However, recent studies suggest that sperm quality has a profound influence on ICSI outcomes and selection of sperm based on functional characteristics along with morphology and motility may significantly improve fertilization, embryo quality, implantation, and take home baby rates in ICSI. These new sperm selection procedures has led to “New era in sperm selection procedure” which are different or complementary to routine sperm processing techniques such as “swim up or density gradient centrifugation procedure”. In order to establish such techniques comprehensive understanding of sperm functions including: sperm membrane functional characteristics, sperm surface proteins, and sperm DNA chromatin integrity and maturity, are essential.Materials and Methods: In the first part of the study, we implemented the sperm functional characteristics test, then the relation of these test with semen parameters, and ICSI outcomes including fertilization, embryonic stage and quality, implantation and pregnancy rates were obtained. In the second part of the study different sperm characteristics upon which sperm can be selected including the sperm surface charge, the Zeta potential and the sperm surface receptor, the hyaluronic acid (HA) receptor were studied and functional characteristicof sperm selected in these procedures was compared to their control group, in order to confirm the efficiency of these techniques. In the third part, once the efficiency of each technique was confirmed they were implemented for ICSI procedure in two different trails.Results: The results, the first part of the study, showed that assessment of protamine deficiency, chromatin integrity by CMA3 staining, sperm chromatin dispersion test, tunnel, and comet assay show significant correlation with semen quality and ICSI outcomes. Thus suggesting these tests are suitable for assessment of sperm functional characteristics. Then, the efficiency of Zeta and HA sperm selection procedure based on previous studies were evaluated and the results, of the second part of the study, showed that both techniques are efficient to select normal sperm in term of sperm morphology, normal protamine content and DNA integrity, however, Zeta procedure was more efficient for selecting sperm with DNA integrity while the HA method can more efficiently select sperm with normal morphology. Following confirmation of the efficiency of these two Novel procedures we implemented these two procedures in ICSI trails along with the appropriate controls. The third part of the study, these trials showed that both techniques significantly improve fertilization rate but in our trails only the Zeta procedure significantly improved implantation and pregnancy rates. In a single case study we implemented this procedure for couple with 11 failed IVF/ICSI cycles which resulted in successful pregnancy. Further trails, including multicenter trails, are also being carried out to further verify the efficiency of the Zeta procedure on ICSI outcome.Conclusion: The results of these studies, along with complementary studies in the literature suggest that the novel sperm selection procedure for ICSI should become gradually mandatory for implementation of ICSI procedure.