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Hum. Reprod. Advance Access published online on August 26, 2005
Human Reproduction, doi:10.1093/humrep/dei249
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
Received March 27, 2005
Revised July 6, 2005
Accepted July 15, 2005

Article

The use of the modified hypo-osmotic swelling test for the selection of immotile testicular spermatozoa in patients treated with ICSI: a randomized controlled study

Hassan N. Sallam 1*, Ashraf Farrag 1, Abdel-Fattah Agameya 1, Yehia El-Garem 2, and Fathy Ezzeldin 3

1 Departments of Obstetrics and Gynaecology, the University of Alexandria, Alexandria, Egypt; The Alexandria Fertility Centre, Alexandria, Egypt
2 Departments of Andrology, the University of Alexandria, Alexandria, Egypt; The Alexandria Fertility Centre, Alexandria, Egypt
3 The Alexandria Fertility Centre, Alexandria, Egypt

* To whom correspondence should be addressed.
Hassan N. Sallam, E-mail: hnsallam{at}link.net


  Abstract

BACKGROUND: Various methods for the selection of viable sperm from among immotile testicular spermatozoa for use in ICSI have been described in non-randomized studies. We have conducted a randomized controlled study to compare the use of the modified hypo-osmotic swelling (HOS) test (50% culture medium + 50% Milli-Q grade water) with that of sperm selection on the basis of their morphology alone. METHODS: A total of 79 couples with immotile testicular spermatozoa treated with ICSI were randomly assigned into two groups. In the first group, spermatozoa used for injection were selected using the modified HOS test, while in the second group spermatozoa were selected on the basis of their morphology. RESULTS: The fertilization rate was significantly higher in the HOS test group (43.6%) compared with the no-HOS test group (28.2%) [odds ratio (OR) 2.494; 95% confidence interval (CI) 1.606-3.872]. The pregnancy and ongoing pregnancy rates were also higher in the HOS test group (27.3% versus 20.5%) compared with the no-HOS test group (5.7% versus 2.9%) (OR 6.188, 95% CI 1.282-29.860; and OR 8.743, 95% CI 1.050-72.783, respectively). CONCLUSIONS: The use of the modified HOS test for the selection of viable sperm from among immotile testicular spermatozoa for ICSI results in higher fertilization, pregnancy and ongoing pregnancy rates compared with morphological selection.

Keywords: azoospermia/hypo-osmotic swelling test/ICSI/immotile spermatozoa/total asthenospermia.
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