title: The effectiveness of flow cytometric sorting of human sperm (MicroSort®) for influencing a child's sex.
abstract: BACKGROUND
  Flow cytometric sorting can be used to separate sperm based on sex chromosome content. Differential fluorescence emitted by stained X- vs. Y-chromosome-bearing sperm enables sorting and collection of samples enriched in either X- or Y-bearing sperm for use to influence the likelihood that the offspring will be a particular sex. Herein we report the effectiveness of flow cytometric sorting of human sperm and its use in human ART procedures.
  
  
  METHODS
  This prospective, observational cohort study of the series of subjects treated with flow cytometrically sorted human sperm was conducted at investigational sites at two private reproductive centers. After meeting inclusion criteria, married couples (n = 4993) enrolled to reduce the likelihood of sex-linked or sex-limited disease in future children (n = 383) or to balance the sex ratio of their children (n = 4610). Fresh or frozen-thawed semen was processed and recovered sperm were stained with Hoechst 33342 and sorted by flow cytometry (n = 7718) to increase the percentage of X-bearing sperm (n = 5635) or Y-bearing sperm (n = 2083) in the sorted specimen. Sorted sperm were used for IUI (n = 4448) and IVF/ICSI (n = 2957). Measures of effectiveness were the percentage of X- and Y-bearing sperm in sorted samples, determined by fluorescence in situ hybridization, sex of babies born, IVF/ICSI fertilization- and cleavage rates, and IUI, IVF/ICSI, FET pregnancy rates and miscarriage rates.
  
  
  RESULTS
  Sorted specimens averaged 87.7 ± 5.0% X-bearing sperm after sorting for X and 74.3 ± 7.0% Y-bearing sperm after sorting for Y. Seventy-three percent of sorts were for girls. For babies born, 93.5% were females and 85.3% were males after sorting for X- and Y-bearing sperm, respectively. IUI, IVF/ICSI, and FET clinical pregnancy rates were 14.7%, 30.8%, and 32.1%, respectively; clinical miscarriage rates were 15.5%, 10.2%, and 12.7%.
  
  
  CONCLUSIONS
  Flow cytometric sorting of human sperm shifted the X:Y sperm ratio. IUI, IVF/ICSI and FET outcomes were consistent with unimpaired sperm function. Results provide evidence supporting the effectiveness of flow cytometric sorting of human sperm for use as a preconception method of influencing a baby's sex.
  
  
  BACKGROUND
  NCT00865735 (ClinicalTrials.gov).
authors.affiliation: Genetics & IVF Institute, 3015 Williams Dr, Fairfax, VA 22031, USA. Dkarabinus@msn.com.
authors.forename: David S
authors.initials: DS
authors.lastname: Karabinus
authors.forename: Donald P
authors.initials: DP
authors.lastname: Marazzo
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Stern
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Potter
authors.forename: Chrispo I
authors.initials: CI
authors.lastname: Opanga
authors.forename: Marisa L
authors.initials: ML
authors.lastname: Cole
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Johnson
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Schulman
mesh_terms: D002469:Cell Separation / Q000379:methods*; D041321:Chromosomes, Human, X / Q000235:genetics; D041322:Chromosomes, Human, Y / Q000235:genetics; D005260:Female; D005307:Fertilization in Vitro; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007231:Infant, Newborn; D007315:Insemination, Artificial; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D015203:Reproducibility of Results; D012743:Sex Preselection / Q000379:methods*; D012744:Sex Ratio; D020554:Sperm Injections, Intracytoplasmic; D013094:Spermatozoa / Q000166:cytology* / Q000378:metabolism