Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Nov 10, 2015; 4(4): 113-123
Published online Nov 10, 2015. doi: 10.5317/wjog.v4.i4.113
Use of hyaluronic acid for sperm immobilisation and selection before intracytoplasmic sperm injection: A systematic review and meta-analysis
Laurentiu Craciunas, Nikolaos Tsampras, Martina Kollmann, Laura Stirbu, Nicholas John Raine-Fenning
Laurentiu Craciunas, Martina Kollmann, Nicholas John Raine-Fenning, Department of Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
Nikolaos Tsampras, Department of Obstetrics and Gynaecology, St. Mary’s Hospital, Central Manchester University Hospitals Foundation Trust, Manchester M13 9WL, United Kingdom
Laura Stirbu, Department of Obstetrics and Gynaecology, St. Remigius Hospital, 51379 Leverkusen, Germany
Author contributions: Craciunas L designed the review protocol; Craciunas L and Tsampras N performed the literature search and identified studies; Craciunas L and Kollmann M extracted the data from included studies; Stirbu L verified the extracted data; Craciunas L performed analysis in Review Manager; Craciunas L wriote the initial draft; Tsampras N, Kollmann M, Stirbu L and Raine-Fenning NJ contributed with comments and agreed the final version of the paper.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Review manager file with statistical code available from the corresponding author at lcraciunas@doctors.org.uk.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Laurentiu Craciunas, Department of Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom. lcraciunas@doctors.org.uk
Telephone: +44-744-7907121 Fax: +44-115-9513666
Received: March 26, 2015
Peer-review started: March 31, 2015
First decision: April 27, 2015
Revised: July 25, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: November 10, 2015
Processing time: 228 Days and 11.1 Hours
Abstract

AIM: To appraise critically the published randomised controlled trials (RCTs) reporting on the effectiveness of using hyaluronic acid (HA) for sperm immobilisation and selection before intracytoplasmic sperm injection (ICSI).

METHODS: Two authors used the PICO Method in order to perform a comprehensive literature search of the standard medical databases in June 2015. Data from the included studies was extracted independently by two authors using a predefined pro-forma. Review Manager (RevMan) was used to calculate the combined outcomes where multiple studies contributed with their results. Risk ratio (RR) with a 95%CI using the Mantel-Haenszel method was calculated for binary data variables. Heterogeneity was measured using the χ2 test and quantified using I2. In case of substantial heterogeneity (P < 0.10 for χ2 test or I2 > 50%) the combined outcome was calculated using the random effects model. The results from the meta-analysis were displayed as forest plots. The guideline of the Cochrane Collaboration was used to assess the risk of bias and it was illustrated as a risk of bias graph.

RESULTS: The systematic literature search identified 166 different studies related to sperm immobilisation and selection for ICSI. Eleven RCTs involving 13719 oocyte intracytoplasmatic injections with sperm immobilised and selected using HA or polyvinylpyrrolidone (PVP) were included in this systematic review and meta-analysis. There was low heterogeneity among the included trials (χ2 = 16.86, df = 11, P = 0.11; I2 = 35%). There was no statistical difference between HA and PVP groups in terms of fertilisation rate (RR = 1.01; 95%CI: 0.99-1.03; z = 0.75; P = 0.45), good embryos rate (RR = 1.01; 95%CI: 0.96-1.06; z = 0.30; P = 0.76), live birth rate (RR = 1.15; 95%CI: 0.86-1.54; z = 0.92; P = 0.36), clinical pregnancy rate (RR = 1.04; 95%CI: 0.92-1.17; z = 0.62; P = 0.53) and implantation rate (RR = 1.17; 95%CI: 0.94-1.46; z = 0.40; P = 0.16). The quality of most of the included studies was moderate to poor because of unclear randomisation technique, inadequate allocation concealment and blinding.

CONCLUSION: This systematic review and meta-analysis provides evidence of similar efficiency between using HA or PVP for sperm immobilisation and selection before ICSI.

Keywords: Hyaluronic acid; Sperm; Intracytoplasmic sperm injection

Core tip: Hyaluronic acid (HA) has been proposed as a physiological alternative to polyvinylpyrrolidone (PVP) for use as a selection medium to reduce sperm motility as a solution for the reported toxicity and unknown long term effects of PVP. We performed a systematic review and meta-analysis of eleven randomised controlled trials involving 13719 oocyte intracytoplasmatic injections with sperm immobilised and selected using HA or PVP. There was no difference between HA and PVP groups in terms of fertilisation, embryo quality, clinical pregnancy, implantation and live birth rates.