Comparison of ICSI Outcomes Between Microfluidic and Conventional Sperm Selection Methods: A Systematic Review and Meta-Analysis

Abstract

In recent years, intracytoplasmic sperm injection (ICSI) has become the main selected option in more than half of the assisted reproductive technologies (ARTs) cycles conducted each year. Selecting the most competent sperm cells with highest fertilization potential is crucial to improve clinical outcomes following ICSI procedure. Microfluidic (MF) chips have emerged as a new alternative to conventional methods for selecting high-quality spermatozoa with minimal DNA fragmentation. However, due to the lack of consensus about the effects of MF sperm selection on ICSI outcomes, in the present study, we systematically reviewed and meta-analyzed the impact of MF on fertilization rate (FR), embryo quality (EQ), euploidy rate (ER), pregnancy rate (PR), and live birth rate (LBR) following ART procedures. A systematic comprehensive literature search of the PubMed, Scopus, and Web of Science databases was conducted to determine the impact of MF on fertility outcomes compared to conventional methods. Meta-analysis using random effects model was used to estimate pooled odds ratios (ORs) and weighted mean differences (WMDs) for various ART outcome measures. The search identified 1714 records, of which 21 articles were included in the review. MF significantly increased the rate of fertilization (OR = 1.04; 95% CI: 1.00–1.07; and WMD = 7.24, 95% CI: 6.93, 7.91) and EQ (OR = 1.44; 95% CI: 1.30–1.60), while nonsignificantly increasing the ER (OR = 1.20; 95% CI: 0.92–1.58), PR (OR = 1.09; 95% CI: 0.94–1.25), and LBR (OR = 1.27; 95% CI: 0.99–1.62). Moreover, subgroup analyses revealed that MF chips resulted in significantly higher FR and improved EQ in unexplained infertile and higher PR in male factor infertility patients. These results indicate that couples with a history of male factor or unexplained infertility may benefit from MF–based sperm selection.