Selecting sperm for assisted reproduction: is PICSI or MACS more effective?

This study investigated sperm selection techniques in couples undergoing assisted reproduction (AR).

They found that the choice of sperm selection techniques should be based on female age. 

Assisted reproduction (AR) is used to help infertile couples. Male infertility (MI) is the cause in 30-50% of cases. MI can be caused by a number of issues. One issue is sperm DNA fragmentation. (SDF). SDF can cause damage to sperm cells. This can reduce sperm count (SC) and motility (SM; movement).

A type of AR technique used for MI is intracytoplasmatic sperm injection (ICSI). This involves injecting a single sperm into a mature egg. There are several sperm selection techniques that can identify the best quality sperm for ICSI. This can improve fertility outcomes.

Physiological intracytoplasmic sperm injection (PICSI) is a sperm selection technique. PICSI uses a protein called hyaluronan as a marker of low SDF. Magnetic-activated cell sorting (MACS) is another selection technique. MACS uses a protein called annexin V as a marker of SDF. It is unclear if PICSI or MACS is associated with better fertility outcomes in couples undergoing ICSI. 

This study included 396 couples undergoing ICSI. Participants were randomly assigned to PICSI or MACS. SDF was measured 3 weeks before treatment. The main fertility outcomes measured were clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR). 

CPR was similar in PICSI and MACS patients. Implantation rates (IR) were also similar between the groups. There was no difference in fertility outcomes when different age groups for male partners were considered. However, the CPR was higher in the MACS group for women under 30 compared to women aged 30-35 years. Women in this age and treatment group also had higher OPR and IR.  

The authors concluded that the choice of sperm selection technique should be based on female age.

Women between the ages of 30 and 35 in the PICSI group tended to have higher fertility outcomes. However, this was not statistically significant. This could be because not enough patients were included in the analysis. This study did not look at the live birth rate. More studies are needed.