Annexin V-MACS in infertile couples as method for separation of sperm without DNA fragmentation

Objective: To determine the effect of using MACS technology on clinical pregnancy, as a method for separation of damaged sperm in infertile patients. Methods: 136 infertile men having normal semen parameters in accordance with WHO 2010 criterion, undergoing ICSI cycle were enrolled during the course of the study. The patients were prospectively randomized and enrolled after oocyte retrieval and were assigned to the ICSI group, PICSI group or MACS group. Embryo development and clinical pregnancy were assessed. In 17 randomized MACS patients, sperm DNA fragmentation was tested in the presumptive apoptotic and no apoptotic spermatozoa fractions. Results: Similar results were obtained between groups for the following parameters: fertilization rates of 78.97% (95% confidence interval [CI]: 74.37-83.57), 70.15 %(95% CI: 63.98-76.33) and 80.28%(95% CI: 73.74-86.81) for ICSI, PICSI and MACS group, respectively; Number of Day-3 embryos was 5.04 (95% CI: 4.09-5.98), 5.17(95% CI: 4.24-6.10) and 5.59(95% CI: 4.31-6.87) for ICSI, PICSI and MACS group, respectively; number of freezing embryos in blastocyst stage was 0.78 (95% CI: 0.251.31), 0.70(95% CI: 0.27-1.14) and 1 (95% CI: 0.37-1.6) for ICSI, PICSI and MACS group, respectively. However, clinical pregnancy rates of 58.1% for MACS group versus 40.4% and 27.3% for PICSI and ICSI group, respectively, were showed statistical difference (P=0.019). DNA fragmentation index for the two sperm MACS fraction showed statistical differences (P=0.000), MACS reduced the D.F.I of the sperm sample. Conclusions: The use of MACS technology improves the clinical pregnancy on infertile couples and can be applied as a method for sperm separation, discriminating sperm with high DNA fragmentation.