Poster presentation ESHRE 2015-P032: Does swim down sperm preparation technique increase the blastulation rate and the ongoing pregnancy rate compared to density gradient sperm preparation technique in ICSI cycles?

1. The Superiority of Swim Down Technique compared to
Density Gradient Technique in preparing Semen Samples
before ICSI: A Prospective Randomized Clinical Trial
A. Metwalley1
, M. Fawzy2
, A. Ahmed1
, S. Jaya1
, B. Ghaith1
, M. Sabry2
, A. Barakat1
.
1
Al Baraka Fertility Hospital, IVF, Manama, Bahrain.
2
IbnSina IVF Center IbnSina Hospital, IVF, Sohag, Egypt.
Results
Summary answer
There was a statistical significant increase in
the blastulation rate (71%) (P<0. 0001) and
the ongoing pregnancy rate (64%) (P<0.0001)
when using swim down sperm preparation
technique before ICSI.
Study question
Does swim down sperm preparation
technique increase the blastulation rate and
the ongoing pregnancy rate compared to
density gradient sperm preparation technique
in ICSI cycles?
There were no statistical significant
differences between both studied groups
as regard mean age, body mass index, dose
of FSH/HMG used, number of neither
oocytes collected nor number of
stimulation days. The blastulation rate in-
group I show statistically significant
increase (71%) compared to (53%) in-
group II (P<0.0001). We could also
document a statistically significant
difference increase in the pregnancy rate
in-group I (64%) compared to (54%) in-
group II (P<0.0001).
Wider implications of the findings
Utilizing sperm natural motility for sperm
preparation can be applied at any ICSI
units. Avoiding multiple centrifugation
steps using swim down-100% considering
the sperm natural powers for separation
can reflect a semi natural sperm
preparation for ICSI. Application for virally
infected semen can also be evaluated.
Registered at Clinical trial.org with number: NCT02328534
What is known already
Density gradient centrifugation while
considered as a conventional technique for
ICSI sperm preparation, recommended by the
WHO laboratory manual 2010; it is not
efficient enough to produce sperm
populations free of DNA damage, because the
technique are not physiological and not
modeled on the sperm selection processes
occurring at the female genital tract (Henkel
2012). Migration based protocols including
the swim down, based upon the migration of
the motile sperms down the discontinuous
gradient.
A prospective randomized multi-centric
clinical trial of 890 couples enrolled into the
study after singing the informed consent and
after approved from ethical committees of the
participating centers at the period from
February 2013 to December 2014.
Study design, size & duration
Semen samples of 890 couples in two ICSI
centers (Al Baraka Fertility Hospital, Manama
Bahrain) and (Ibn Sina IVF Center- Ibn Sina
Hospital, Sohag Egypt) were allocated
randomly into two groups; group I prepared
using direct swim down over a 100% silica
containing media (ALL Grad® 100', Life
Global®) and group II prepared using the
conventional density gradient technique.
Materials and Methods
Limitations, reason for caution
We excluded moderate to severe
oligozoospermia cases, since the yielded
sperm count is lesser in swim-down
compared to the density-gradient
technique. The inappropriate use of swim
down-100% technique with non-
progressive motility sperm due to very
poor outcome. We did not study the effect
of sperm exposure to Silica solution 100%
solution for lengthy periods.
Before Processing
Silica Solution
Semen
Sample
After Processing
Cloudiness after sperm
migration