Sperm separation plays a critical role in assisted reproductive technology. Based on migration, density gradient centrifugation and filtration, a properly selected sperm could help in increasing
assisted reproductive outcomes in teratozoospermia (TZs). The current study aimed to assess the
prognostic value of four sperm selection techniques: density gradient centrifugation (DGC), swim-up
(SU), DGC-SU and DGC followed by magnetic-activated cell sorting (DGC-MACS). These were
evaluated using spermatozoa functional parameters. A total of 385 infertile couples underwent the
procedure of intracytoplasmic sperm injection (ICSI), with an isolated teratozoospermia in the male
partner. Semen samples were prepared by using one of the mentioned sperm preparation techniques.
The improvements in the percentage of normal mature spermatozoa, rate of fertilization, cleavage,
pregnancy and the number of live births were assessed. The normal morphology, spermatozoa
DNA fragmentation (SDF) and chromatin maturity checked by using chromomycin A3 (CMA3)
with DGC-MACS preparation were better compared to the other three methods. Embryo cleavage,
clinical pregnancy and implantation were better improved in the DGC-MACS than in the other tested
techniques. The DGC-MACS technique helped in the selection of an increased percentage of normal
viable and mature sperm with intact chromatin integrity in patients with teratozoospermia