title: "Physiologic ICSI": hyaluronic acid (HA) favors selection of spermatozoa without DNA fragmentation and with normal nucleus, resulting in improvement of embryo quality.
abstract: OBJECTIVE
  To evaluate the role of hyaluronic acid (HA) for sperm selection before intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Three prospective studies.
  
  
  METHODS
  Private assisted reproduction center in Italy.
  
  
  METHODS
  Study 1: 20 men. Study 2: 15 men. Study 3: 206 couples treated with ICSI on a limited number of oocytes per patient (1-3) in accordance with Italian IVF law.
  
  
  METHODS
  Study 1: determination of sperm DNA fragmentation of HA-bound spermatozoa versus spermatozoa in polyvinylpyrrolidone (PVP). Study 2: assessment of nuclear morphology of HA-bound spermatozoa versus spermatozoa in PVP. Study 3: randomized study comparing conventional PVP-ICSI to ICSI in which the spermatozoa are selected for their capacity to bind to HA (HA-ICSI).
  
  
  METHODS
  Study 1: sperm DNA fragmentation rate. Study 2: sperm nucleus normalcy rate according to motile sperm organellar morphology examination criteria. Study 3: fertilization, embryo quality and development, and implantation and pregnancy.
  
  
  RESULTS
  Spematozoa bound to HA show a significant reduction in DNA fragmentation (study 1) and a significant improvement in nucleus normalcy (study 2) compared with spermatozoa immersed in PVP. Furthermore, injection of HA-bound spermatozoa (HA-ICSI) significantly improves embryo quality and development (study 3).
  
  
  CONCLUSIONS
  Hyaluronic acid may optimize ICSI outcome by favoring selection of spermatozoa without DNA fragmentation and with normal nucleus. Furthermore, HA may also be used to speed up the selection of spermatozoa with normal nucleus during intracytoplasmic morphologically selected sperm injection (IMSI).
authors.affiliation: Reproductive Medicine Unit, GynePro Medical Centers, Via T. Cremona, 8, 40137, Italy. l.parmegiani@gynepro.it
authors.forename: Lodovico
authors.initials: L
authors.lastname: Parmegiani
authors.forename: Graciela Estela
authors.initials: GE
authors.lastname: Cognigni
authors.forename: Silvia
authors.initials: S
authors.lastname: Bernardi
authors.forename: Enzo
authors.initials: E
authors.lastname: Troilo
authors.forename: Walter
authors.initials: W
authors.lastname: Ciampaglia
authors.forename: Marco
authors.initials: M
authors.lastname: Filicori
mesh_terms: D002467:Cell Nucleus / Q000187:drug effects / Q000502:physiology; D053938:DNA Fragmentation / Q000187:drug effects; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000494:pharmacology*; D008297:Male; D009865:Oocytes / Q000166:cytology / Q000187:drug effects / Q000502:physiology*; D011205:Povidone / Q000494:pharmacology; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013094:Spermatozoa / Q000187:drug effects / Q000502:physiology*
chemical_list: D006820:Hyaluronic Acid; D011205:Povidone