Cumulative live birth rates in ICSI cycles with donated oocytes are not improved by magnetic-activated cell sorting: A retrospective study in unselected males

Abstract Research question Does magnetic-activated cell sorting (MACS) increase cumulative live birth rates (CLBRs) or improve clinical parameters of reproductive success in couples undergoing ICSI with donor oocytes? Design Retrospective multicenter observational study. Data were compiled from unselected couples who underwent ICSI cycles with donated oocytes in fifteen Spanish IVIRMA fertility clinics (January 2008 to Feb 2020). Patients were divided into reference (standard semen processing, n=40,103) and MACS (additional sperm selection step by MACS, n=900) groups. CLBRs were plotted in Kaplan-Meier curves and compared using the Mantel-Cox test. Proportions were compared with Fisher's exact test. A mixed-effects logistic regression model was developed to adjust results to clinically relevant variables. Results The MACS group showed a 27.1% CLBR after one embryo was replaced and 81.6% after four; the reference group had CLBRs of 19.6% and 78.5%, respectively. CLBR in the MACS group was 4.2% after five oocytes were used and 75.5% after fifteen; for the reference group, CLBRs were 7.8% and 78.3%, respectively. Differences between Kaplan-Meier curves of each group were statistically significant for both measurements. No significant differences between the groups were found in terms of CLBR per embryo transfer (ET) or in classical clinical outcomes such as pregnancy and live birth rates per ET. Conclusions Even though MACS sperm selection slightly increased the cumulative live birth rate per embryo transferred compared to the reference group, this change was not clinically meaningful. MACS should not be recommended indiscriminately to all infertile patients undergoing ICSI with donated oocytes as a sperm processing add-on.