ART
Conditions
Keywords
ICSI
Brief summary
The primary objective of this study is to evaluate whether the percentage of good quality embryo formation following Intracytoplasmic Sperm Injection (ICSI) is improved with the use of ZyMot method of microfluidic sperm separation compared to density gradient.
Detailed description
During an in vitro fertilization (IVF) cycle, eggs are removed from a woman's ovaries via a minor surgical procedure and are inseminated with sperm in order to create embryos. The insemination process can be via standard IVF or intracytoplasmic sperm injection (ICSI.) Standard IVF is the process of placing thousands of sperm in a culture dish with one or more eggs and allowing them to interact on their own. ICSI is the process by which one sperm is directly injected into each egg. Prior to using the sperm for insemination, a semen sample is processed and washed in order to obtain the healthiest sperm. A standard sperm preparation procedure is density gradient, in which the sperm is spun via centrifugation and separated from the seminal fluid. An alternate method is via microfluidics, by which the sperm swim up a microfluidic gradient created by a microporous filter between two chambers of a device. Sperm that are capable of navigating through this filter and reaching the end chamber are presumed to be the healthiest sperm. There is some data revealing that ZyMot microfluidics yields healthier sperm compared to the density gradient technique. The aim of the study is to evaluate whether good quality embryo formation is any different following insemination with sperm separated by microfluidics compared to density gradient. On the day of oocyte retrieval, the sperm sample will be split between the two different processing methods: density gradient and ZyMot microfluidics. In the event that there are 6 or more mature oocytes and ICSI will be used for insemination, half of the oocytes will be inseminated with sperm processed by density gradient and half with sperm processed by ZyMot microfluidics. The percentage of good quality embryo formation will be compared between the two groups.
Interventions
DEVICEZyMot Multi Sperm Separation Device (850 ul)
850 uL of untreated semen will be directly deposited into the inlet port of the ZyMotTM Multi device, followed by placement of 750 uL culture medium in the outlet port and throughout the upper collection chamber. The device will then be incubated in a humidified 37C CO2 incubator for 30 minutes. During incubation, the healthiest and most motile sperm will swim through the microporous filter and into the upper collection chamber, where they will be recovered via the outlet port. 500 uL of the sperm sample will be removed and placed in a separate tube for analysis and insemination.
Density gradient centrifugation will be performed using a one-layer preparation of 90% Isolate in 15 mL conical tubes. Semen will be layered over 1 mL of gradient and then centrifuged for 15 min at 300xg. The supernatant will be removed and discarded. The sperm pellet will be washed by mixing with Multipurpose Handling Medium Complete and centrifuging the sample for 5 min at 400xg. After the wash, the supernatant is removed and discarded and the pellet is re-suspended in culture medium, assessed for sperm parameters, and held at room temperature until insemination.
Sponsors
NYU Langone Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
for Patients: 1. Patient(s) over 18 years of age 2. Patient(s) capable of providing informed consent 3. Use or possible use of ICSI for oocyte insemination 4. At least 6 mature oocytes at time of insemination via ICSI
Exclusion criteria
for Patients: 1. Patient under 18 y/o 2. Patients not capable of providing informed consent 3. Use of IVF for insemination 4. Less than 6 mature oocytes at time of rertrieval 5. Anonymous donor sperm source 6. Surgically retrieved sperm 7. Sperm sample not sufficient for use with ZyMot device Inclusion Criteria for Donors: 1. Donor(s) over 18 years of age 2. Donor(s) capable of providing informed consent 3. Use of ejaculate sperm, fresh or frozen, for insemination 4. Sufficient sperm for use of ZyMot
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Good Quality Blastocyst Formation | Culture Day 5 or 6 | Good quality embryos will be defined as blastocyst stage embryos on day 5 or 6 of culture with an overall quality grade of good or fair. Embryo morphology assessment includes two parts: an Overall Grade and the Stage. Grading is a subjective assessment of the overall quality of the embryo as good, fair, or poor, and is based on assessment of certain characteristics of the embryo, such as fragmentation, symmetry, inner cell mass (ICM) quality and trophectoderm quality. The percentage will be reported for both arms (ZyMot compared to density gradient). |
Countries
United States
Participant flow
Pre-assignment details
The trial enrolled 108 unique individuals grouped into 54 patient/sperm-source dyads. Each enrolled dyad produced oocyte units. Oocytes from the same dyad were assigned to the density gradient (control) arm, ZyMot (treatment) arm, or both depending on the criteria met by the oocyte units, meaning the same 54 dyads were assigned to both study arms. Dyads who produced insufficient samples for ZyMot processing were withdrawn.
Participants by arm
| Arm | Count |
|---|---|
| Study Population Individuals in patient/sperm-source dyads with oocyte units that were analyzed. | 66 |
| Total | 66 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Conversion to IUI due to low response | 1 | 1 |
| Overall Study | Low Oocyte Yield | 8 | 8 |
| Overall Study | Not ICSI Insemination | 7 | 7 |
| Overall Study | Poor Sperm Quality | 2 | 2 |
| Overall Study | Withdrawal by Subject | 2 | 2 |
Baseline characteristics
| Characteristic | Study Population |
|---|---|
| Age, Continuous | 36.9 years STANDARD_DEVIATION 0.6 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 65 Participants |
| Sex: Female, Male Female | 33 Participants |
| Sex: Female, Male Male | 33 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 33 | 0 / 33 |
| other Total, other adverse events | 0 / 33 | 0 / 33 |
| serious Total, serious adverse events | 0 / 33 | 0 / 33 |
Outcome results
Primary
Percentage of Good Quality Blastocyst Formation
Good quality embryos will be defined as blastocyst stage embryos on day 5 or 6 of culture with an overall quality grade of good or fair. Embryo morphology assessment includes two parts: an Overall Grade and the Stage. Grading is a subjective assessment of the overall quality of the embryo as good, fair, or poor, and is based on assessment of certain characteristics of the embryo, such as fragmentation, symmetry, inner cell mass (ICM) quality and trophectoderm quality. The percentage will be reported for both arms (ZyMot compared to density gradient).
Time frame: Culture Day 5 or 6
Population: Participants refer to dyads. Information form one of the completed dyads was not collected.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ZyMot Separation | Percentage of Good Quality Blastocyst Formation | 51.4 percentage of embryos | Standard Deviation 5.1 |
| Density Gradient Centrifugation | Percentage of Good Quality Blastocyst Formation | 51.7 percentage of embryos | Standard Deviation 5.4 |