Purpose: The selection of high-quality spermatozoa affects embryo quality and, consequently, the success rates of clinical outcomes. This study aimed to evaluate the efficacy of a cumulus cell-based sperm selection method for identifying high-quality spermatozoa and to determine whether this process enhances ICSI clinical outcomes.
Methods: A total of 88 ICSI cycles were analyzed, generating 640 embryos, 331 in the control group and 309 in the study group. Standard density gradient centrifugation was applied in the control group, while the study group underwent an additional selection step using cumulus cell columns (CCC) in microcapillary pipettes. Embryo development was monitored through time-lapse imaging up to the blastocyst stage, and clinical outcomes were also recorded.
Results: Results demonstrated a significant reduction in sperm DNA fragmentation following CCC selection (37.08% vs. 23.36%, p = 0.0001). Embryos derived from CCC-selected sperm exhibited accelerated developmental kinetics and fewer cleavage abnormalities. Clinical outcomes were markedly enhanced in the study group, with higher implantation (58% vs. 28.4%), chemical pregnancy (81.8% vs. 50%), clinical pregnancy (77.3% vs. 25%), and live birth rates (72.7% vs. 25%) compared with controls (all p = 0.001).
Conclusions: The Use of cumulus cell-based sperm selection improves embryo quality and reproductive outcomes.
Keywords: ICSI; cumulus cell column; embryo morphokinetics; sperm selection.
© 2025 The Author(s). Reproductive Medicine and Biology published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Reproductive Medicine.