Special Edition: PICSI

The ICSI bitsy PICSI swam in the petri dish;
Down came the pipette and sucked up our little wish
Out came the blasts that were followed by the pain
until the ICSI bitsy frosties go up the spout again.

*takes a bow*

First of all, if you haven't read this post, you may want to go check it out first. It covers some of the basics as far as sperm DNA damage in male-factor infertility. If you've got all that down, then just continue here.

I mentioned, what feels like eons ago, a study we participated in during our fresh IVF cycle. This study is testing the 'Effectiveness of the Use of The PICSI Dish in the Selection of Sperm for Intracytoplasmic Sperm Injection (ICSI) For Patients Having a Low Versus High Proportion of Hyaluronan Binding Sperm (HBA).' You can read about it here if you want an official National Institutes of Health description, otherwise, I'll give you the high points.

First. Hyaluronan Binding. Hyalu-who-nan? Hyaluronan. What is it? Hyaluronan is a substance that is found in many tissues of the body, most imporantly for us in the cells that surround the human egg. It is possible to test sperm for their ability to bind to hyaluronan using the Hyaluronan Binding Assay (HBA).

Why might it be important to know the HBA of sperm?

Mature sperm have a higher ability to bind with hyaluronic acid, which means they have a higher ability to bind with an egg. Studies have shown that high HBA binding sperm have better morphology, more motility, and greater maturity, than sperm that don't bind, or don't bind well. It would serve to reason, therefore, that these 'super' sperm (mature, normal-shaped, and motile) would have lower rates of chromosomal abnormalities, and higher probability of producing a pregnancy. This is one of the things this study attempts to evaluate.

What about the PICSI?

Is it just a cute name that rhymes with ICSI? Yes, basically. This is the trademark name of a sperm-selection device created by Biocoat, Inc. Guess how it works? The PICSI dish is a petri dish coated with, you guessed it, hyaluronan dots. Sperm are place in the dish and the ones that bind to the hyaluronan dots are selected for ICSI. Get it? The idea is that the sperm that are the best-looking and most well-behaved (and therefore 'normal') will be used for ICSI, thereby giving you, me, and all the other MFI-ers a better shot at getting knocked up. Theory is great. Theory is perfect, this one is yet unproven.

If the PICSI dish is proven to be effective, it would be an incredible breakthrough. Currently, sperm are selected for ICSI by embryologists based on looks. Of course, the sperm that are the most normal-shaped (head-size particularly), are the ones that get picked. This is a good step, but where's the science in that? Further, studies have shown that there are all kinds of aneuploidies, or abnormal chromosomes, even within those 'normal' looking sperm. And gosh, we only had 0-1% out of 1.5 million 'normal' looking sperm...sounds a bit like hand-selection could be compared to looking for a needle in a haystack.

Wouldn't it be great if there were a test available that could knowingly select the sperm that were normal on the inside? I don't know about you, but I learned a long time ago that beauty is only skin deep; don't judge a book by it's cover; and all that jazz. While I wouldn't want a two tailed, giant-headed sperm chosen for ICSI, I would love it if another method were available to ensure success.

You can read a description of PICSI and HBA, and see a video of sperm-binding to the hyaluronan on the Biocoat website.

How does the study work?

This study wanted to know if PICSI would be useful to patients with high binding sperm, low binding sperm, none, or both. First, the sperm undergo HBA testing to determine if they were high or low binding. Once that information is known, the patient is randomized to be in one of five groups.

• Low HBA scorers who will have PICSI
• Low HBA scorers control (no PICSI)
• High HBA scorers who will have PICSI
• High HBA scorers control (no PICSI)
• High HBA scorers not included in study at all

Once assigned to a treatment (or no treatment) group, the eggs are fertilized using sperm selected using either PICSI or traditional methods only, and things continue in the standard way from that point forward. The fertilization rates, embryo development, and of course pregnancy outcome will be assessed.

How did we fare in the PICSI study?

Well, I am obviously not showing off belly bumps and posting symptom lists, so we know how the IVF/ICSI turned out, but that has nothing to do with the study.

My husband's HBA binding score was >75%. I found this out before we did the cycle and was very encouraged. Anything over 65% is considered high-binding according to the study. So theoretically, things sounded really good. I wasn't able to find out which group he was assigned to until after the study, and as it turns out he was assigned to the high-binding control group. Alas, for our IVF/ISCI, we had no PICSI. We had standard selection methods, and, well, who knows? Maybe the high-binding sperm explains our excellent fertilization rates.

Will we use PICSI in the future?

First of all, I hope there is no fresh future. We still have two hatched blasts in deep freeze and I'm wishing for a successful frozen embryo cycle next month. My RE told me that using PICSI is an option, as they will use the test without us being in the study. He didn't suggest it however. He feels that because my husband's sperm are already high-binding, PICSI likely wouldn't offer us anything additional as far as selection is concerned.

So? Did you know about PICSI? Did you participate in a study, or elect to use the PICSI dish for selection in an IVF cycle? Have you had an HBA score assessed? If so, what was it?

Thanks for reading.

Further Reading?

Hyaluronan binding and IVF Fertilization Rates

Hyaluronic acid binding and Cellular Maturity and Viability

Biocoat Website