Sperm Selection Using Cumulus Cell Column Improves Sperm DNA Integrity, Embryo Morphokinetics, and Clinical Outcomes Following ICSI: A Randomized Clinical Trial

TL;DR

Using cumulus cell columns to select sperm improves DNA quality, embryo development, and pregnancy success in ICSI treatments.

Contribution

A new sperm selection method using cumulus cell columns is shown to enhance clinical outcomes in ICSI.

Findings

CCC selection significantly reduced sperm DNA fragmentation compared to standard methods.

Embryos from CCC-selected sperm showed faster development and fewer abnormalities.

Clinical outcomes like implantation and live birth rates were significantly higher with CCC selection.

Abstract

The selection of high‐quality spermatozoa affects embryo quality and, consequently, the success rates of clinical outcomes. This study aimed to evaluate the efficacy of a cumulus cell‐based sperm selection method for identifying high‐quality spermatozoa and to determine whether this process enhances ICSI clinical outcomes.

A total of 88 ICSI cycles were analyzed, generating 640 embryos, 331 in the control group and 309 in the study group. Standard density gradient centrifugation was applied in the control group, while the study group underwent an additional selection step using cumulus cell columns (CCC) in microcapillary pipettes. Embryo development was monitored through time‐lapse imaging up to the blastocyst stage, and clinical outcomes were also recorded.

Results demonstrated a significant reduction in sperm DNA fragmentation following CCC selection (37.08% vs. 23.36%, p = 0.0001). Embryos derived from CCC‐selected sperm exhibited accelerated developmental kinetics and fewer cleavage abnormalities. Clinical outcomes were markedly enhanced in the study group, with higher implantation (58% vs. 28.4%), chemical pregnancy (81.8% vs. 50%), clinical pregnancy (77.3% vs. 25%), and live birth rates (72.7% vs. 25%) compared with controls (all p = 0.001).

The Use of cumulus cell‐based sperm selection improves embryo quality and reproductive outcomes.

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