EJMS

Abstract

Rational: Intra Cytoplasmic Sperm Injection (ICSI) is reliable method for single sperm selection and injection to for a large number of patients suffers from oligospermia. Human oocytes are naturally surrounded by Hyaluronic acid (HA), which play a role as Physiological selector for Intra-Cytoplasmic Sperm Injection (PICSI). Mature spermatozoa able to bind to and digest HA have the best chance of reaching the oocyte and pursue fertilization. The intact human spermatozoa are binds to immobilize HA surrounding oocyte In Vitro and those with reduced risk of chromosomal imbalance or chromatin diseases. Objective: Selection of spermatozoa by HA before intracytoplasmic sperm injection (ICSI) might help to optimize the outcome of the treatment. Thus, our study was aimed to compare ICSI result, based on the methods of hyaluronic acid or traditional method for sperm selection in ICSI. Patients and Methods: Prospective study, on 120 couples with male factor infertility and normal females was conducted at the assisted reproduction unit in the International Islamic Centre for Population Studies and Research (IICPSR), Al-Azhar University, Egypt, during the period from October 2013 and September 2015. All cases were clinically evaluated and eligible for analysis by using inclusion and exclusion criteria. All studied males were subjected to sperm preparation and prepared to pursue traditional (ICSI) and physiological sperm selection by PICSI method. ICSI was performed simultaneously of different oocytes from the same females using an ejaculated sperm by two methods from the same husband. ICSI outcomes were compared in the two sequential attempts performed, respectively. Number and quality of oocyte, fertilization rates, embryo cleavage rate and pregnancy rate were recorded. Data were collected and tabulated for performing statistics. Results: The obtained data revealed that using ICSI and PICSI has no significant effect on the fertilization rate in Normozoospermia, Oligozoospermia and Asthenozoospermia respectively. Also, both techniques have no effects on the numbers of cleavage embryos and cleavage rate were statistically non-significant. Referring to percentage of embryos with top grade it was calculated that there was no effect of both techniques on quality of embryos in Normozoospermic group. While, in oocytes injected with sperm using PICSI in Oligozoospermic and Asthenozoospermic showed increase in the percentage of embryos with top quality, these increases were statistically significant. Finally, percentage of pregnancy rate showed increases in all groups manipulated with PICSI technique and this increase were statistically significant. Conclusion: This study shed more light on the physiological sperm selection method (PICSI) which could improve fertilization rate and pregnancy rate compared to traditional selected sperm in ICSI. It was concluded that PICSI technique in ART is one of very important technique that improve fertilization in cases of low fertilization rate after ICSI.