MACS: does this procedure really help sperm quality?
ICSI (Intracytoplasmatic sperm injection) or microinjection was revolutionary in IVF treatment.
It quickly became a technique used worldwide to better the fertilization rates in IVF cycles.
After the event of ICSI and finding a way to achieve pregnancy for a high number of impossible
cases using conventional IVF, the male factor fell into a category where not as much research was
done and the bulk of fertility problems researched were on the female factor- women were told to lose weight,
eat healthy food, relax, get psychological help, try acupuncture, tai chi or reflexology while men had ICSI.
Fortunately things are changing…20 years ago infertility was thought to be due mostly to the female factor,
but in 2014 female infertility is now reportedly equal to male infertility and both partners are found to
have fertility problems in 30% of all cases.
What has happened? Are men really that bad off in 2014? Honestly,
I believe that life is more stressful for all, but also we are now taking into account
that ICSI cannot overcome all male problems. Numerous reports are published on how sugary drinks,
cannabis, being overweight, eating red meat etc are all harmful for sperm. We are testing DNA fragmentation
and the genetic side of sperm. There are dozens of anti-oxidant vitamin preparations on the
market to better sperm… but is there anything else we can do?
Actually, over the past years a technique that was invented over 20 years ago as been recovered
to better sperm samples the day they are to be used for artificial insemination or IVF. The method is
called MACS (Magnetic Activated Cell Sorting).
The method is quite ingenious and simple. Tiny magnetic balls are dropped into a sperm sample- these magnetic
balls have been coated with annexin V. Annexin V is a substance that has affinity for phosphatidylserine, a substance
found in the cell membrane (and of course in the sperm cell membrane in our case) and it begins to be discernible at
the cell surface when the sperm cell is about to die. So if we drop the magnetic annexin V balls into a sperm sample
and pour the sperm sample through a column with magnets, we are capable of eliminating the sperm that is about to die
and is useless in fertilizing an egg. This way we can magnetically “pull out” a high percentage of bad sperm in a sample.
This leaves the best sperm to be used. This helps the embryologist pick the healthiest sperm when choosing sperm for microinjection
and in a sperm sample to be used in Artificial Insemination, the concentration of good sperm is higher.
Comparing studies over the past years it seems that MACS is a safe and efficient method to select sperm with constant results.
When used along with standard sperm selection methods in Assisted Reproduction, MACS may improve pregnancy rates. This method is
one that can be used only in certain cases. It must be noted that MACS is not a total revolution in Assisted Reproduction but,
achieving pregnancy is a multi-factorial equation and sometimes just improving one factor can mean attaining a dream…