#ESHREjc report: are sperm selection techniques a panacea? Indications for the use of physiological intracytoplasmic sperm injection (PICSI) in medically assisted reproduction

Despite the wide use of ART over the past few decades, the efficiency in terms of pregnancies and live birth rates (LBR) has reached a standstill (Eskew and Jungheim, 2017). Several factors could be attributed to the sub-optimal effectiveness of treatment, ranging from treatment regimes, laboratory conditions, as well as biological variability deriving from male and female factors (Gleicher et al., 2019). In terms of male factors, several methods have been developed aiming to improve ART outcomes by focusing on spermatozoa selection for downstream application in treatment (Lepine et al., 2019). The selection of spermatozoa in the clinic becomes vital, considering that only a few hundred sperm will reach the ampulla in vivo where fertilization occurs naturally (Williams et al., 1993). Therefore, one of the reasons behind the sub-optimal ART outcomes is the challenge the human operator faces to identify the sperm subpopulation with the capacity to fertilize the oocyte and provide optimal developmental competence (Sakkas et al., 2015).