Initial Experience with Macs - Magnetic Activated Cell Sorting - For Differentiating Between Apoptotic and Non-Apoptotic Spermatozoa for Patients with Previous IVF Failures

Introduction:

During normal ICSI procedure only motile sperm are chosen for injection. However, some of these seemingly ‘live’ sperm are actually already undergoing apoptosis and as such will not produce viable embryos. MACS is a method using Magnetic Activated Cell Sorting to improve the quality of sperm preparations by removing apoptotic spermatozoa.

Aim:

To report initial experience using the MACS ® system in IVF ICSI cycles in couples with previous failed IVF ICSI cycles.

Materials & Methods:

A retrospective analysis of 22 treatment cycles for 19 couples with between 4 and 14 previous failed cycles who were advised to use MACS.

Spermatozoa that are in the process of apoptosis start to express phophatidylserine (PS) on their external membrane. During the MACS procedure, apoptotic cells are magnetically labelled with Annexin V Reagent which binds to the PS. The cells are then passed through a separation column that is located in a magnetic field. Unwanted cells are attracted to the micro-beads within the column and are retained. Non-apoptotic viable sperm cells are not labelled by the reagent and pass through the column to be collected for later use. As such this is a functional as opposed to an analytical separation.

Results:

22 patients, age range from 25 to 44, cycle number 1-15 in our unit, number of oocytes 1-29. Transfers were made to 18 patients (4 PGD patients had no healthy embryos for transfer). There were 6 confirmed pregnancies (33%) with 1 ending in miscarriage, and so far one birth of twins. All pregnancies were in patients that had previously suffered from repeated IVF failure.

Conclusions:

There are reports in the literature that cell sorting improves the fertilisation and/or pregnancy rate but our group of patients is not large enough to make any definitive conclusion, and further study is needed. To the best of our knowledge, however, this is the first time MACS has been used in an IVF unit in Israel.