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Journal of Assisted Reproduction and Genetics

, Volume 30, Issue 4, pp 479–485 | Cite as

Sperm selection using magnetic activated cell sorting (MACS) in assisted reproduction: a systematic review and meta-analysis

  • Monica Gil
  • Valerie Sar-Shalom
  • Yolisid Melendez Sivira
  • Ramon Carreras
  • Miguel Angel Checa
Technological Innovations

Abstract

Purpose

To determine whether the use of Magnetic Activated Cell Sorting (MACS) as a sperm selection technique improves ART success rates in couples undergoing assisted reproduction treatment.

Methods

Systematic review and meta-analysis of prospective randomized trials. Two reviewers conducted study selection and data extraction independently.

Results

Five studies (prospective randomized trials) that comprised 499 patients were included. Sperm selection using MACS resulted in statistically significant differences in pregnancy rates when compared with density gradient centrifugation and swim-up techniques (RR = 1.50, 95 % CI 1.14–1.98). No differences were found between the groups according to the implantation (RR = 1.03, 95 % CI 0.80–1.31) and miscarriage (RR = 2.00, 95 % CI 0.19–20.90) rates.

Conclusions

MACS appears to be a safe and efficient method to select functional sperm with consistently good results. This technique may improve pregnancy rates when used to complement standard sperm selection methods in ART.

Keywords

MACS Sperm selection Annexin V Pregnancy DNA fragmentation Meta-analysis 

References

  1. 1.
    Alvares Sedó C, Uriondo H, Lavolpe M, Noblia F, Papier S, Nodar F. Clinical outcome using non-apoptotic sperm selection for ICSI procedures: report of 1 year experience. Fertil Steril. 2010;94 Suppl 4:S232. doi: 10.1016/j.fertnstert.2010.07.902.CrossRefGoogle Scholar
  2. 2.
    Aziz N, Said T, Paasch U, Agarwal A. The relationship between human sperm apoptosis, morphology and the sperm deformity index. Hum Reprod. 2007;22(5):1413–9. doi: 10.1093/humrep/dem016.PubMedCrossRefGoogle Scholar
  3. 3.
    Aziz N, Said TM, Paasch U, Grunewald S, Glander HJ, Agarwal A. Impact of apoptosis on sperm morphology indices. Fertil Steril. 2005;84 Suppl 1:S407. doi: 10.1016/j.fertnstert.2005.07.1064.CrossRefGoogle Scholar
  4. 4.
    Aziz N, Said TM, Paasch U, Grunewald S, Sharma RK, Agarwal A. The cause why apoptotic sperm have poor morphology profile as assessed by the sperm deformity index (SDI): a prospective study. Fertil Steril. 2006;86(Issue 3, Suppl 2):S506. doi: 10.1016/j.fertnstert.2006.07.1400.CrossRefGoogle Scholar
  5. 5.
    Bochev I, Gavrilov P, Kyurkchiev S, Shterev A, 27th Annual Meeting of the European Society on Human Reproduction and Embryology (ESHRE). Sperm motility improvement after magnetic-activated cell sorting in men with astheno/oligo-asthenozoospermia. Hum Reprod. 2011;26 suppl 1:i133. doi: 10.1093/humrep/26.s1.75.Google Scholar
  6. 6.
    Buzzi J, Valcarcel A, Lombardi E, Oses R, Rawe V, Young E, et al. Magnetic activated cell sorting (MACS) improves oocyte donation results associated to severe male factor infertility. Hum Reprod. 2010;25 suppl 1:i118–52. doi: 10.1093/humrep/de.25.s1.001.Google Scholar
  7. 7.
    Cortés-Gutiérrez E, Dávila-Rodríiguez M, Lóopez-Fernández C, Fernández J, Gosáalvez J. Evaluación del daño en el DNA espermático. Actas Urológicas Españolas. 2007;31(2):120–31. doi: 10.4321/S0210-48062007000200008.PubMedCrossRefGoogle Scholar
  8. 8.
    De Vantéry Arrighi C, Hervé L, Chardonnens D, Agostini A. Removal of spermatozoa with externalized phosphatidylserine from sperm preparation in human assisted medical procreation: effects on viability, motility and mitochondrial membrane potential. Reprod Biol Endocrinol. 2009;7(1):1–12. doi: 10.1186/1477-7827-7-1.PubMedCrossRefGoogle Scholar
  9. 9.
    Dirican EK, Özgün OD, Akarsu S, Okhan A, Özge E, Mukaddes U, et al. Clinical outcome of magnetic activated cell sorting of non-apoptotic spermatozoa before density gradient centrifugation for assisted reproduction. J Assist Reprod Genet. 2008;25:375–81. doi: 10.1007/s10815-008-9250-1.PubMedCrossRefGoogle Scholar
  10. 10.
    Duru NK, Morshedi MS, Schuffner A, Oehninger S. Cryopreservation-thawing of fractionated human spermatozoa is associated with membrane phosphatidylserine externalization and not DNA fragmention. J Androl. 2001;22(4):646–51.PubMedGoogle Scholar
  11. 11.
    Grunewald S, Paasch U, Glander HJ. Enrichment of non-apoptotic human spermatozoa after cryopreservation by immunomagnetic cell sorting. Cell Tissue Bank. 2001;2:127–33. doi: 10.1023/A:1020188913551.PubMedCrossRefGoogle Scholar
  12. 12.
    Grunewald S, Reinhardt M, Blumenauer V, Said TM, Agarwal A, Hmeidan FA, et al. Increased sperm chromatin decondensation in selected nonapoptotic spermatozoa of patients with male infertility. Fertil Steril. 2009;92(2):572–7. doi: 10.1016/j.fertnstert.2008.07.1705. Elsevier Ltd.PubMedCrossRefGoogle Scholar
  13. 13.
    Herrero MB, Delbes G, Troueng E, Holzer H, Chan PTK, 28th Annual Meeting of the European Society on Human Reproduction and Embryology (ESHRE). Differential enrichment of sperm with no DNA strand breaks using magnetic activated cell sorting (MACS) in men with various categories of semen parameters. Hum Reprod. 2012;27 suppl 2:ii121–50. doi: 10.1093/humrep/27.s2.73.CrossRefGoogle Scholar
  14. 14.
    Huang C, Lee T, Chen C, Wu G, Lee C, Lee M, et al. Sperm preparation by magnetic-activated cell sorting improve the sperm-zona pellucida binding capacity and reduces apoptotic sperm. Hum Reprod. 2009;24 suppl 1:2147–i218.Google Scholar
  15. 15.
    Khalid SN, Qureshi IZ. Pregnancy rate improves in couples with unexplaines infertility following intrauterine insemination (IUI) with magnetically selected non-apoptotic sperms. Fertil Steril. 2011;96(3):S25. doi: 10.1016/j.fertnstert.2011.07.104. Elsevier Ltd.CrossRefGoogle Scholar
  16. 16.
    Khalid SN, Qureshi IZ. Effect of magnetic selected sperm on fertilization and embryo development: an animal model study. Fertil Steril. 2011;96(3):S169. doi: 10.1016/j.fertnstert.2011.07.659. Elsevier Ltd.CrossRefGoogle Scholar
  17. 17.
    Lee H, Liu C, Lee M. Sperm preparation by magnetic. Activated Cell Sorting (MACS) reduced apoptotic sperm and improved acrosome reaction for unexplained infertility. Fertil Steril. 2009;S143.Google Scholar
  18. 18.
    Lee TH, Liu CH, Shih YT, Tsao HM, Huang CC, Chen HH, et al. Magnetic-activated cell sorting for sperm preparation reduces spermatozoa with apoptotic markers and improves the acrosome reaction in couples with unexplained infertility. Hum Reprod. 2010;25(4):839–46. doi: 10.1093/humrep/deq009.PubMedCrossRefGoogle Scholar
  19. 19.
    Losada C, Ortega I, Pacheco A, Bronet F, 28th Annual Meeting of the European Society on Human Reproduction and Embryology (ESHRE). Can MACS as a sperm preparation technique improve clinic results in patients with Kartagener syndrome? Hum Reprod. 2012;27 suppl 2:ii162–205.CrossRefGoogle Scholar
  20. 20.
    Makker K, Agarwal A, Sharma RK. Magnetic activated cell sorting (MACS) Utility in assisted reproduction. Indian J Exp Biol. 2008;46:491–7.PubMedGoogle Scholar
  21. 21.
    Nadalini M, Tarozzi N, Di Santo M, Borini A, 27th Annual Meeting of the European Society on Human Reproduction and Embryology (ESHRE), Annexin V magnetic-activated cell sorting versus swim-up for the selection of human sperm in ART: is the new approach better then the traditional one? Hum Reprod. 2011;26 suppl 1:i130.Google Scholar
  22. 22.
    Paasch U, Grunewald S, Agarwal A, Glander HJ. Activation pattern of caspases in human. Fertil Steril. 2004;81 Suppl 1:802–9. doi: 10.1016/j.fertnstert.2003.09.030.PubMedCrossRefGoogle Scholar
  23. 23.
    Paasch U, Grunewald S, Fitzl G, Glander HJ. Deterioration of plasma membrane is associated with activated caspases in human spermatozoa. J Androl. 2003;24(2):246–52.PubMedGoogle Scholar
  24. 24.
    Paasch U, Grunewald S, Wuendrich K, Jope T, Glander HJ. Immunomagnetic removal of cryo-damaged human spermatozoa. Asian J Androl. 2005;7(1):61–9. doi: 10.1111/j.1745-7262.2005.00009.x.PubMedCrossRefGoogle Scholar
  25. 25.
    Paasch U, Sharma RK, Gupta AK, Grunewald S, Mascha EJ, Thomas A, et al. Cryopreservation and thawing is associated with varying extent of activation of apoptotic machinery in subsets of ejaculated human spermatozoa. Biol Reprod. 2004;71:1828–37. doi: 10.1095/biolreprod.103.025627.PubMedCrossRefGoogle Scholar
  26. 26.
    Pesce M, De Felici M. Purification of mouse primordial germ cells by MiniMACS magnetic separation system. Dev Biol. 1995;170:722–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Polak De Fried E, Denaday F. Single and twin ongoing pregnancies in two cases of previous ART failure after ICSI performed with sperm sorted using annexin V microbeads. Fertility and Sterility. 2010. doi: 10.1016/j.fertnstert.2009.12.037. Elsevier Ltd.
  28. 28.
    Rawe V. Columnas de anexina como metodología de selección de espermatozoides no apoptóticos durante lCSl. Reproducción Humana. 2009;6(1).Google Scholar
  29. 29.
    Rawe V, Alvares Sedó C, Uriondo H, Papier S, Miasnik S, Nodar F. ICSI outcome using annexin V columns to select non-apoptotic spermatozoa. Fertil Steril. 2009;92 Suppl 3:S73–4.CrossRefGoogle Scholar
  30. 30.
    Rawe V, Álvarez G, Uriondo H, Papier S, Miasnik S, Nodar F. Separación magnética por columnas de anexinas V: “filtrado molecular” para la selección de espermatozoides no apoptóticos. Reproducción. 2009;24:104–14.Google Scholar
  31. 31.
    Rawe V, Uriondo Boudri H, Alvares Sedó C, Carro M, Papier S, Nodar F. Healthy baby born after reduction of sperm DNA fragmentation using cell sorting before ICSI a. Reproductive BioMedicine Online. 2010;20:320–3. doi: 10.1016/j.rbmo.2009.12.004.PubMedCrossRefGoogle Scholar
  32. 32.
    Robinson L, Gallos ID, Conner SJ, Rajkhowa M, Miller D, Lewis S, et al. The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis. Hum Reprod. 2012;27(10):2908–17. doi: 10.1093/humrep/des261.PubMedCrossRefGoogle Scholar
  33. 33.
    Romany L, Garrido N, De Los Santos MJ, Aparicio B, Pellicer A, Meseguer M, et al. Effect of sperm selection by anexin-V sorting prior to ICSI in ovum donation program. Preliminary data. Reproductive BioMedicine Online. 2012;24(Suppl1):S2.CrossRefGoogle Scholar
  34. 34.
    Romany L, Garrido N, Fernandez JL, Pellicer A, Meseguer M, 28th Annual Meeting of the European Society on Human Reproduction and Embryology (ESHRE). Assisted reproduction results improvements due to magnetic activated cell sorting (MACS) depletion of apoptotic sperm is not mediated by sperm DNA fragmentation decrease. Hum Reprod. 2012;27 suppl 2:ii121–50. doi: 10.1093/humrep/27.s2.73.CrossRefGoogle Scholar
  35. 35.
    Romany L, Meseguer M, Garcia-Herrero S, Pellicer A, Garrido N. Magentic activated sorting selection (MACS) of nonapoptotic sperm (NAS) improves pregnancy rates in homologous intrauterine insemination (IUI). Preliminar data. Fertil Steril. 2010;94(4):S14. doi: 10.1016/j.fertnstert.2010.07.055. Elsevier Ltd.CrossRefGoogle Scholar
  36. 36.
    Romany L, Meseguer M, García-Herrero S, Romero JL, Pellicer A, Garrido N, et al. Magnetic activated sorting of non-apoptotic sperm result in improved embryo quality in ovum donation cycles with intracytoplasmic sperm injection. Hum Reprod. 2010;25 suppl 1:i8.Google Scholar
  37. 37.
    Said T, Agarwal A, Grunewald S, Rasch M, Baumann T, Kriegel C, et al. Selection of Nonapoptotic Spermatozoa As a New Tool for Enhancing Assisted Reproduction Outcomes: An In Vitro Model. Biol Reprod. 2006;74:530–7. doi: 10.1095/biolreprod.105.046607.PubMedCrossRefGoogle Scholar
  38. 38.
    Said TM, Agarwal A, Zborowski M, Grunewald S, Glander HJ, Paasch U. Utility of Magnetic Cell Separation as a Molecular Sperm Prepartion Technique. J Androl. 2008;29(2):134–42. doi: 10.2164/jandrol.107.003632.Utility.PubMedCrossRefGoogle Scholar
  39. 39.
    Said TM, Aziz N, Paasch U, Grunewald S, Glander HJ, Agarwal A. Elimination of Apoptotic Sperm as a Measure for Enhancing Morphological Quality as Assessed by the Sperm Deformity (SDI). Fertil Steril. 2005;84 Suppl 1:448–9.CrossRefGoogle Scholar
  40. 40.
    Said TM, Grunewald S, Paasch U, Rasch M, Agarwal A, Glander HJ. Effects of magnetic-activated cell sorting on sperm motility and cryosurvival rates. Fertil Steril. 2005;83(5):1442–6. doi: 10.1016/j.fertnstert.2004.11.052.PubMedCrossRefGoogle Scholar
  41. 41.
    Said TM, Land JA. Effects of advanced selection methods on sperm quality and ART outcome: a systematic review. Hum Reprod Updat. 2011;17(6):719–33. doi: 10.1093/humupd/dmr032.CrossRefGoogle Scholar
  42. 42.
    San Celestino M, Agudo D, Alonso M, Sanjurjo P, Becerra D, Bronet F, et al. Improved pregnancy rate after sperm magnetic separation technique in egg donation cycles using frozen sperm samples. Hum Reprod. 2011;26 suppl 1:i123–48.Google Scholar
  43. 43.
    Tavalee M, Deemeh M, Arbabian M, Nasr-Esfahani M. Density gradient centrifugation before or after magnetic-activated cell sorting: which technique is more useful for clinical sperm selection? J Assit Reprod Genet. 2012;29:31–8. doi: 10.1007/s10815-011-9686-6.CrossRefGoogle Scholar
  44. 44.
    Van Thillo G, Guidobono M, Young E, Ruiz Jorro MR, Vila M, Rawe V. Biological safety and live births after selection of non-apoptotic spermatozoa during ICSI. Fertil Steril. 2011;96 Suppl 3:S160–1. doi: 10.1016/j.fertnstert.2011.07.629. Elsevier Ltd.CrossRefGoogle Scholar
  45. 45.
    Vermes I, Haanen C, Steffens-Nakken H, Reutelingsperger CP. A novel assay for apoptosis: flow cytometric detection of phosphatidylserine expression of early apoptotic cells using fluorescein labeled Annexin V. J Immunol Methods. 2005;184(1):39–51.CrossRefGoogle Scholar
  46. 46.
    Vilela M, Tiveron M, Lombardi C, Viglierchio MI, Marconi G, Rawe V, et al. Implantation potential after vitrification of embryos obtained using magnetic active sperm sorting combined with Annexin V during ICSI. Hum Reprod. 2011;26 suppl 1:i200.Google Scholar
  47. 47.
    Winkle T, Ditzel N, Gagsteiger F. Possibilities of spremisolation by the MACS-System. Fertil Steril. 2006;86 Suppl 2:130–131.v.CrossRefGoogle Scholar
  48. 48.
    Young E, De Caro R, Marconi G, Lombardi E, Young E, Tiveron M, et al. Reproductive outcome using Annexin V columns for non-apoptotic sperm selection. Hum Reprod. 2010;25 suppl 1:i6–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Monica Gil
    • 1
  • Valerie Sar-Shalom
    • 1
  • Yolisid Melendez Sivira
    • 1
  • Ramon Carreras
    • 2
  • Miguel Angel Checa
    • 2
  1. 1.Hospital Universitari del Mar: International Master in Reproductive MedicineAutonomous University of BarcelonaBarcelonaSpain
  2. 2.Department of Obstetrics and Gynecology, Hospital Universitari del MarAutonomous University of BarcelonaBarcelonaSpain

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