It is estimated that 15% of couples seek help to overcome infertility problems. One-third of infertility problems are caused by the male factor. The remaining two-thirds are women-related problems and unclear causes, and appear to be evenly distributed between male and female components.

1. New Sperm Selection Techniques
(IMSI, PICSI) To Select Healthy
Sperm

2. • It is estimated that 15% of couples seek help to overcome infertility problems.
• One-third of infertility problems are caused by the male factor.
• The remaining two-thirds are women-related problems and unclear causes and
appear to be evenly distributed between male and female components.
• Assisted reproductive technology (ART) is used in approximately 2-4% of births.

3. • Spermatogenesis methods, in particular, attempt to replicate in vitro the natural
process by which viable sperm cells are separated from other ejaculate
components as they actively migrate through the cervical mucus.
• Viable sperm cells are separated from other components of the ejaculate as early
as possible during the laboratory procedure.

4. • To select sperm cells, sperm isolation or isolation methods are available.
• Conventional techniques, such as simple washing methods, density gradient
centrifugation (DGC), swim-up, swim-down, and glass wool filtration, select
sperm cells based on motility and morphology.
• However, none of these conventional methods can assess important factors that
affect the fertilizing ability of sperm, such as oxidative stress and DNA integrity.

5. • Consequently, several advanced sperm selection techniques were developed to
select sperm with high DNA integrity to improve ART success rates.
• Several of these techniques are currently in use for this purpose, each relying on
different characteristics to select the best sperm.

6. Physiological intra-cytoplasmic sperm injection (PICSI)
• This method is based on the fact that hyaluronic acid (HA) is important for the
selection of functionally competent spermatozoa during fertilization.
• HA is a major component of the cumulus matrix surrounding the human oocyte
but is also a natural selector of developmentally mature sperm.
• Currently, two options are available to perform this technique: either using plastic
culture dishes with HA hydrogel microdots or using an alternative HA-containing
adhesive medium known as "sperm slow".

7. Intracytoplasmic morphologically selected injection (IMSI)
• According to research, sperm classified as morphologically "normal" at standard
optical resolution and magnification (x200-x400) may have ultrastructural defects.
• Many of these anomalies have been linked to hidden chromosomal defects,
excessive DNA fragmentation, abnormal centriolar function, and other factors.
• These anomalies can obstruct fertilization, cause post-fertilization arrest, or even
disrupt embryo development.

8. • To overcome the aforementioned shortcomings, observations can be made using
an inverted light microscope with high-power optics at x6000-x6600
magnification, allowing embryologists to assess sperm morphology in real-time.
• In this regard, IMSI is beneficial for patients (men with low numbers, low motility,
and increased abnormalities in their sperm samples) as well as couples
experiencing repeated implantation failure or miscarriage.

9. Conclusion
• Several sperm selection methods are available to process sperm for use in ART.
• Each infertile couple must be thoroughly examined to determine the best method
of sperm preparation.
• It is the IVF clinic's responsibility to select cases that will benefit from these
methods, as their routine use in all cases can have negative consequences.