In vitro fertilisation




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Special Sperm Diagnostic Testing

Who needs special sperm diagnostic testing?

  • Repeated intrauterine insemination (IUI) failures
  • Repeated in vitro fertilization (IVF) failures
  • Unexplained infertility
  • Men over 40 years old with single abnormal semen parameter. For example: severe teratozoospermia (normal form <1%) or asthenozoospermia (forward motility <20%) or high number of round cells >5%
  • Men with recurrent urinary / genital infections
  • History of recurrent miscarriages

1. Sperm DNA Fragmentation Assay

  • The sperm nucleus and DNA integrity are correlated with fertilization, development of embryos and pregnancy rates
  • This assay is able to differentiate between sperms with DNA fragmentation and intact DNA
  • The sperm DNA fragmentation (SDF) associates with pregnancy outcome in intrauterine insemination (IUI). When SDF is greater than 30%, the chance of delivery is significantly decreased from 19.0% to 1.5%. When SDF level is greater than 30%, couples should be advised to undergo in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to maximize the pregnancy outcome. The use of physiological ICSI (PICSI) is also advised under these conditions. PICSI uses hyaluronic acid as a chemo-attractant to select mature and physiologically normal sperm for ICSI

2. Sperm Hyaluronan Binding Assay

  • Hyaluronic Acid is a major component of the cumulus cells surrounding the oocytes, it serves as a chemo-attractant for sperms and induces sperms hyper-activation
  • Only the mature sperms are able to bind to hyaluronan and zona pellucida. The percentage of sperm binding to Hyaluronic Acid is an indicator to determine the maturity and physiological function of the sperms
  • The Hyaluronan Binding Assay is a unique tool for suspected male infertility and in assessing the ability of spermatozoa to fertilize human ooctyes


  1. Ahmadi, A and Ng SC. 1999. Developmental capacity of damaged spermatozoa. Human Reprod. 14:2279-2285.
  2. Bungum M, Humaldan P, Axmon A., et al. 2007. Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome. Human Reproduction. 22(1): 174-179.
  3. Breznik Pregl B, Kovacic B, Vlaisavljevic V. 2013. Are sperm DNA fragmentation, hyperactivation, and hyaluronan binding ability predictive for fertilization and embryo development in in vitro fertilization and intracytoplasmic sperm injection? Fertil Steril. 99(5):1233-41.
  4. Huszar G. 2012. Sperm testing and ICSI selection by hyaluronic acid binding: the hyaluronic acid coated glass slide and petri dish in the andrology and IVF laboratories. Practical manual of in vitro fertilization: advanced methods and novel devices. New York: Springer. 241-257.
  5. Worilow K.C, Eid S, Woodhouse D., et al. (2013). Use of hyaluron in selection of sperm for ICSI; a significant improvement in clinical outcomes-multicentre, double-blind randomised trial. Hum Reprod; 28(2): 306¡V314
  6. Yagci Artay, Murk William, Stronk Jill., et al. 2010. Spermatozoa bound to solid state hyaluronic acid show chromatin structure with high DNA chain integrity: an acridine orange fluorescence study. Journal of Andrology. 31(6):566-572.