Evaluation of Sperm Selection Technique Using Hyaluronic Acid Binding During ICSI; A Randomized Controlled Trial

Objective: To compare between Hyaluronan binding system for sperm selection for ICSI procedures (PICSI) and conventional morphology sperm selection. In vitro sperm selection for ICSI is important as it has a direct influence on the paternal contribution of preimplantation embryogenesis. Various laboratory tests were developed to assess the functions of the spermatozoa. Among them, only the tests for sperm DNA fragmentation, hyperactivation of the spermatozoa and the hyaluronan-binding ability are simple and fast. Study Design: A randomized controlled trial where three-hundred cases with male infertility were divided into 3 equal groups according to semen abnormality (oligo, astheno and teratozoospermia) then each group was randomly divided into 2 equal subgroups one underwent PICSI and the other underwent conventional ICSI. The outcomes were fertilization,high quality embryos and clinical pregnancy rate. Results: A significant difference was found in favor of PICSI as regards both high-quality embryos and clinical pregnancy rate in all 3 groups. A significant difference was also found in fertilization rate in favor of PICSI group in both oligozoospermia and teratozoospermia groups but not in asthenozoospermia group. Conclusion: PICSI technique provides better high-quality embryos, fertilization, and clinical pregnancy rates in cases with male factor infertility; however, further studies are needed to define specific criteria for performing PICSI taking into consideration both the expenses and time of the technique