Comparison of microfluid sperm

sorting chip and density gradient

methods for use in intrauterine
insemination cycles
Funda Gode, M.D.,a,b Taylan Bodur, M.D.,b Fatma Gunturkun, Ph.D.,c Ali Sami Gurbuz, M.D.,d
Burcu Tamer, M.Sc.,b Ibrahim Pala, M.Sc.,b and Ahmet Zeki Isik, M.D.b,e
a
Department of Obstetrics and Gynecology, Bahçeşehir University, and e Department of Obstetrics and Gynecology, Istinye
University, Istanbul; b In Vitro Fertilization Unit, Izmir Medicalpark Hospital and c Dokuz Eylul University, Statistics, Izmir;
and d Novafertil In Vitro Fertilization Centre, Konya, Turkey

Objective: To compare the effect of microfluiding sperm sorting chip and density gradient methods on ongoing pregnancy rates (PRs)
of patients undergoing IUI.
Design: Retrospective cohort study.
Setting: Hospital IVF unit.
Patient(s): Couples with infertility undergoing IUI cycles between 2017 and 2018.
Intervention(s): Not applicable.
Main Outcome Measure(s): Ongoing PRs.
Result(s): A total of 265 patients were included in the study. Microfluid sperm sorting and density gradient were used to prepare sperm
in 133 and 132 patients, respectively. Baseline spermiogram parameters, including volume, concentration, motility, and morphology,
were similar between the two groups. Total motile sperm count was lower in the microfluiding sperm sorting group at baseline (35.96

37.69 vs. 70.66
61.65). After sperm preparation sperm motility was higher in the microfluid group (96.34
7.29 vs. 84.42
10.87).
Pregnancy rates were 18.04% in the microfluid group and 15.15% in the density gradient group, and ongoing PRs were 15.03% and
9.09%, respectively. After using multivariable logistic regression and controling for confounding factors, there was a significant in-
crease in ongoing PRs in the microfluid sperm sorting group. The adjusted odds ratio for ongoing pregnancy in the microfluid group
compared with the density gradient group was 3.49 (95% confidence interval 1.12–10.89).
Conclusion(s): The microfluid sperm sorting method significantly increased the ongoing PRs compared with the density gradient
group in IUI cycles. (Fertil SterilÒ 2019;112:842–8. Ó2019 by American Society for Reproductive Medicine.)
El resumen está disponible en Español al final del artículo.
Key Words: Microfluid sperm sorting, pregnancy rates, density gradient, intrauterine insemination cycles, microchip
Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility-
and-sterility/posts/50551-28093

I
ntrauterine insemination is a com- reserve, and sperm parameters, affect within the female genital tract, referred
mon treatment modality for infertile the success of IUI (1). Among these to as capacitation. Sperm capacitation is
couples before starting more com- prognostic factors, total motile sperm performed artificially during the IUI
plex assisted reproductive techniques count is one of the most important (2). procedure using specific techniques (3).
(ART). Many factors, such as the wom- Spermatozoa undergo a series of The purpose of semen processing is to in-
an's age, duration of infertility, ovarian biochemical and structural changes crease the concentration of motile sperm,
as well as to remove seminal plasma,
Received April 6, 2019; revised June 20, 2019; accepted June 25, 2019; published online September 19, debris, prostaglandins (PGs), immotile
2019.
F.G. has nothing to disclose. T.B. has nothing to disclose. F.G. has nothing to disclose. A.S.G. has
sperm, leukocytes, immature germ cells,
nothing to disclose. B.T. has nothing to disclose. _I.P. has nothing to disclose. A.Z.I. has nothing and other substances that could be harm-
to disclose. ful to sperm viability. Therefore, the
Reprint requests: Funda Gode, M.D., In Vitro Fertilization Unit, Izmir Medicalpark Hospital, Izmir,
Turkey (E-mail: funda.gode@gmail.com). sperm used for IUI must be processed
from the seminal fluid, capacitated, and
Fertility and Sterility® Vol. 112, No. 5, November 2019 0015-0282/$36.00
Copyright ©2019 American Society for Reproductive Medicine, Published by Elsevier Inc.
selected based on morphology and
https://doi.org/10.1016/j.fertnstert.2019.06.037 motility to be introduced into the uterine

842 VOL. 112 NO. 5 / NOVEMBER 2019


cavity (4, 5). Several techniques have been developed to improve
sperm recovery and separate functionally competent
spermatozoa.
The swim-up method and density gradient centrifugation
are used frequently to prepare for IUI. In the swim-up method,
motile sperm swim from a prewashed pellet up toward a layer
of fresh medium for selection (6, 7). In density gradient
centrifugation, centrifugal forces are used to separate sperm
in accordance with their density gradient (8). Some studies
support the superiority of one of these techniques to the
other (3). However, a recent review (9) revealed similar
pregnancy rates (PRs) with either technique.
Although these techniques were designed to select a
group of high-quality sperm, there is some concern about po-
tential harmful effects of these procedures on sperm. For
example, the high pressure and force exerted on sperm during
repetitive centrifugation may reduce sperm quality and could
ultimately compromise their natural properties. Sperm in
solid pellets have higher levels of reactive oxygen species
and DNA fragmentation (10, 11). In addition,
centrifugation-based sperm preparation techniques are
labor-intensive and time-consuming, and the outcomes can
vary from technician to technician (12).
The microfluid sperm sorting chips technique was devel-
oped to solve the limitations of these methods (13–17). In this
method, the sperm fluid is injected into a canal that is
<0.5 mm in width, and the healthy sperm are swept out of
the channel into the chip, hence allowing healthy sperm to
be separated from either damaged or dead sperm. This
technique allows accurate selection of motile sperm within
a shorter period of time, yet preserving overall sperm
quality. Also less DNA fragmentation and reactive oxygen
species have been observed in these sperm (12).
Microfluid technology has become widespread in many
infertility clinics with the expectation of increasing clinical
PRs. However, no study has investigated the clinical outcomes
of this procedure during IUI cycles. Therefore, we compared
the sperm parameters and clinical results of the microfluid
sperm sorting and density gradient centrifugation methods
in IUI cycles.
MATERIALS AND METHODS
Patients
This study was a retrospective analysis of clinical records and
approved by the Ethics Committee of Bahcesehir University
Medical School. These women had undergone IUI during
2017–2018 at the IVF center of Izmir Medicalpark Hospital,
Izmir, Turkey.
Two sperm preparation methods, density gradient and
microfluid sperm sorting (microchip), have been used in this
department since 2017. Microfluidic sperm sorting is not a
routine technique in our clinic, but information about this
technique is given to all of the couples admitted to our clinic.
The IUI technique selected is either the patient's or the clini-
cian's preference. Patients who failed previous IUI attempts
as well as those with longer duration of infertility or with
male subfertility might prefer this new technique. Our
VOL. 112 NO. 5 / NOVEMBER 2019
Fertility and Sterility®
attending physicians may also prefer this new technique for
patients who have certain mentioned characteristics.
Clinical characteristics, PRs, and spermiogram parame-
ters were evaluated in each patient, and these parameters
were compared between the two techniques. Inclusion criteria
were unexplained infertility, including failure to conceive for
12 months, female age between 20 and 43 years, basal FSH
level <15 IU/L, bilateral tubal patency confirmed by hystero-
salpingography (HSG), normal spermiogram parameters ac-
cording to the World Health Organization 2010 (18), and
mild male factor (male subfertility) cases with total motile
sperm counts >5 million/mL. The exclusion criteria were
women aged >44 years, bilateral tubal pathology, and total
motile sperm counts <5 million/mL. Only the first IUI cycles
in our center were included in the study.
The primary outcomes were the PR and the ongoing PR.
The secondary outcomes were the spermiogram parameters,
including volume, concentration, and motility before and af-
ter processing using these two techniques.
Ovulation Induction
All patients were evaluated with a baseline transvaginal ultra-
sound examination on day 3 of the menstrual cycle. Ovarian
stimulation included letrozole (5 mg/d) from day 3 of the men-
strual cycle for 5 days followed by a gonadotropin (urinary
FSH; Fostimon, IBSA) injection based on follicle size. The
dosage and duration of the gonadotropin injection was
adjusted according to the clinical condition of the patient.
Ovulation was triggered by an SC injection of recombinant
hCG (250 mg; Ovitrelle, Serono) when at least one mature fol-
licle measured >17 mm. Cycles with more than three domi-
nant follicles were canceled. The IUI was performed with a
disposable IUI catheter 36 hours after the hCG injection. The
luteal phase was supported with 8% P gel (Crinone, Merck Se-
rono) until week 12. The pregnancy result was obtained with a
blood bhCG test on day 14 after insemination, and clinical
pregnancy was confirmed by detecting the gestational sac
on a transvaginal ultrasound. Ongoing pregnancy was defined
as the presence of a viable fetus after 12 weeks of pregnancy.
Semen Preparation Procedure
Semen samples were obtained by masturbation into a sterile,
labeled container after 2–5 days of abstinence. All semen
samples were incubated at 37 C for 30 minutes.
Density Gradient Technique
The density gradient technique was performed with the
following steps. First, a gradient column was prepared by
placing 1 mL 80% gradient media (Origio/medicult Media)
in a centrifuge tube and an additional 1 mL 55% gradient me-
dia layered on top. Next, up to 3 mL of the semen was layered
on top of the 55% layer and centrifuged at 1,400 rpm for
10 minutes. The supernatant and gradient medium just above
the sperm pellet were removed and discarded. The sperm pel-
let was washed with 3 mL sperm wash media, and centrifuged
at 1,600 rpm for 10 minutes. The supernatant was collected
and was resuspended in 0.5 mL sperm wash medium to the
final volume.
843
ORIGINAL ARTICLE: ANDROLOGY

Microfluidic Technique
TABLE 1
Microfluid sperm sorting was performed using the Fertile Plus
chip (Koek Biotechnology), a flow-free dual chambered mi- Baseline clinical characteristics of the study groups.
crofluid single-use chip. The first chamber is the sample inlet, P
and fluid channels are separated from the second collection Characteristics Microchip Gradient SMD value
chamber by a microporous membrane. An untreated semen Female age (y) 31.46
5.40 31.39
4.75 0.01 .91
sample (%850 mL) was injected into the inlet chamber and Male age (y) 35.33
5.33 34.48
5.14 0.15 .19
700 mL of the sperm wash medium, heated to 37 C, was added BMI (kg/m2) 26.10
12.33 25.20
11.79 0.09 .20
Duration of 3.31
2.18 2.80
1.74 0.25 .06
to the microporous membrane (outlet chamber). The chip was infertility (y)
incubated for 30 minutes at 37 C. The sorted 650 mL sperm Day 3 FSH (mIU/mL) 6.21
4.95 5.91
1.42 0.08 .69
sample was collected from the outlet. Day 3 E2 (pg/mL) 50.21
24.68 43.39
19.60 0.31 .16
Duration of 10.45
2.23 10.11
2.37 0.15 .23
stimulation (d)
Statistical Analyses Endometrium (mm) 8.93
2.04 8.90
2.12 0.01 .94
Previous IUI 0.76
0.70 0.14
0.47 0.99 .00a
Categorical variables are presented as numbers and percent- cycles (n)
ages, and continuous variables are presented as mean
SD. Note: Student's t-test. Data were presented as mean
standard deviation. BMI ¼ body mass
index; SMD ¼ standardized mean difference.
The Student's t-test was used to compare continuous vari- a
P< .05.
ables. Categorical variables were compared using the c2 Gode. Microchip and density gradient methods. Fertil Steril 2019.
test. Paired t-test was used for comparing sperm motility in
study groups before and after the application of the sperm
preparation technique. A waterfall plot was constructed to of previous IUI cycles was higher in the microchip group (0.76
demonstrate how the motility of sperm changed for each in-
0.7 vs. 0.14
0.4; P< .05). Female age, male age, body
dividual included. A linear regression model was performed mass index (BMI), endometrial thickness on the day of hCG
to examine the association between the sperm preparation injection, number of dominant follicles, duration of stimula-
technique, the total motile sperm count, and sperm motiliy. tion, and duration of infertility were not different between the
Standardized mean differences were used to examine the bal- groups (P>.05). Spermiogram parameters, including volume,
ance between groups for each baseline characteristics. The concentration, motility, and morphology, were similar be-
standardized difference is defined as: tween the two groups before the sperm was prepared (P>.05).

 After preparation, the sperm concentration was signifi-
x chip  x gradient cantly higher in the density gradient group (34.20
27.91
d ¼ qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi vs. 16.79
13.21; P< .05) but sperm motility was higher in
schip sgradient
2 2

2 the microchip group (96.34
7.29 vs. 84.42
10.87;

The absolute standardized mean difference >0.25 indi-
cates an imbalance for that baseline characteristic. Multivari-
able logistic regression models were used for reduction of
confounding bias. Unadjusted and adjusted logistic regres-
sion models were developed to evaluate the effect of micro-
chip on pregnancy and ongoing PRs. The unadjusted
logistic regression model was applied by only considering
the treatment method (chip or gradient). On the other hand,
the adjusted logistic regression model was developed with
confounding covariates in addition to the treatment method.
The data were analyzed with statistical software R studio.
Results of the statistical tests were considered to be significant
if two-sided P value was < .05.
RESULTS
A total of 265 patients were included. The microfluid sperm
sorting (group 1) and density gradient (group 2) methods
were used to prepare sperm for 133 and 132 patients, respec-
tively. The baseline clinical features of the two groups are
shown in Table 1. According to standardized mean differ-
ences, the clear imbalances were seen between two groups
in total motile sperm and number of previous IUI cycles. Total
motile sperm count was lower in the microchip group before
preparation (35.96
37.69 vs. 70.66
61.65 million/mL;
P< .05) (Table 2). The largest standardized difference was
found in the number of previous IUI cycles (0.99). The number
P< .05). The significant difference in total motile sperm count
before sperm preparation (35.96
37.69 vs. 70.66
61.65
million/mL) disappeared after preparation (22.85
21.12,
18.85
15.08 million/mL; P>.05) (Table 2). According to
paired t-test, the sperm motility rate was significantly
increased in both treatment groups after preparation
(P< .05). The increments of sperm motility rate were 43.84
(52.50
15.46, 96.34
7.29) and 29.27 (55.30
16.53,
84.42
10.87) in the microchip and density gradient groups,
respectively. According to linear regression models, total
motile sperm count after sperm processing was estimated to
be significantly higher in the microchip group compared
with the gradient group (P< .05) The difference in sperm
motility rate was also significantly higher in the microchip
group (P< .05) (Supplemental Table 1, available online).
Waterfall plot of change in sperm motility are shown in
Figure 1. According to this plot most change in sperm motility
was detected in the microchip group. Waterfall plots for the
sperm concentration and total motile sperm count change
were also shown in Supplemental Figures 1 and 2, available
online.
The PRs were 18.4% in the microchip group and 15.15%
in the density gradient group (P>.05). The clinical PRs were
15.03% in the microchip group and 12.87% in the density
gradient group (P>.05). The ongoing PRs were 15.03% in
the microchip group and 9.09% in the density gradient
group (P>.05).

844 VOL. 112 NO. 5 / NOVEMBER 2019

 Fertility and Sterility®

TABLE 2

Sperm parameters of the study groups before and after sperm preparation.
Characteristic Microchip Gradient SMD P value
Baseline Sperm concentration (10 /mL) 6
49.74
34.13 52.66
34.60 0.09 .51
Sperm motility (%) 52.50
15.46 55.30
16.53 0.17 .17
TPMSC 35.96
37.69 70.66
61.65 0.67 .00a
After preparation Sperm concentration (106/mL) 16.79
13.21 34.20
27.91 0.79 .00a
Sperm motility (%) 96.34
7.29 84.42
10.87 1.27 .00a
TPMSC 22.85
21.12 18.85
15.08 0.22 .09
Note: Student's t-test. Data were presented as mean
standard deviation. TPMSC ¼ total motile sperm count (106).
a
P< .05.
Gode. Microchip and density gradient methods. Fertil Steril 2019.

Female age, male age, BMI, duration of infertility, number
of previous IUI cycles, total motile sperm count, and treat-
ment method were included in the adjusted logistic regression
analysis. The results of adjusted and unadjusted logistic
regression models are shown in Table 3. With regard to preg-
nancy, although the PR was higher in the microchip group,
this difference was not statistically significant. Models
adjusted for baseline characteristics produced higher odds ra-
tios compared with unadjusted models, as patients in the
gradient group had better baseline characteristics (Table 3).
According to the unadjusted logistic regression analysis the
odds of pregnancy in the microchip group was 1.53 times
the odds in the gradient group (95% confidence interval
0.74, 3.13; P>.05). However, the odds ratio for pregnancy
in the microchip group compared with the gradient group
was 1.84 (95% confidence interval 0.72, 4.74) after adjusting
for female age, male age, BMI, duration of infertility, number
of previous IUI cycles, and total motile sperm count (P>.05).
According to the unadjusted logistic regression model for
ongoing PR, a statistically significant difference was detected
between the two groups (odds ratio 2.40; P< .05). After using
the multivariable logistic regression and controling for con-
founding factors, the adjusted odds ratio was 3.49 (P< .05).
This significance is interpreted as using the microchip tech-
FIGURE 1
nique increased the chance of ongoing pregnancy by approx-
imately 3.5 times, when compared with the density gradient,
after adjusting for baseline characteristics.
DISCUSSION
Current management of infertility has been influenced by
new technological developments in the field. One of them is
microfluidics, which mimic the natural biophysical and
biochemical environment and provide for more physiological
sperm selection in patients undergoing ART. This method has
begun to be commonly applied in clinical practice; however,
there is little information about the effects of this procedure
on clinical PRs in IUI cycles. To our knowledge this is the first
study to compare a conventional sperm preparation technique
of density gradient centrifugation to the microfluid sperm
sorting with regard to ongoing PRs. There were no differences
in PRs between the groups. However, ongoing PRs (15% vs.
9%) tended to be higher in the microchip group. Thus we de-
tected a 3.5 times higher chance of ongoing pregnancy in the
microchip group after adjusting for baseline characteristics.
One of the most important factors affecting the success of
IUI cycles is the recovered motile sperm count after preparing
the sperm. Conventional preparation techniques are equally
effective according to clinical results. However, some studies
(19–21) have reported that a density gradient is more
advantageous than the swim-up technique in terms of

TABLE 3

Effect of microchip method on pregnancy and ongoing pregnancy

rates.
Pregnancy Ongoing pregnancy
P P
Characteristic OR 95% CI value OR 95% CI value
Unadjusted 1.53 0.74–3.13 .25 2.40 1.03–5.6 .04a
analysis
Adjusted 1.84 0.72–4.74 .21 3.49 1.12–10.89 .03a
analysis
Note: Unadjusted logistic regression analysis. Adjusted logistic regression analysis of sperm
preparation method on pregnancy and ongoing pregnancy, adjusted for female age, male
age, body mass index, duration of infertility, number of previous IUI cycles, and total motile
sperm count. CI ¼ confidence interval; OR ¼ odds ratio.
a
Waterfall plot for changes in sperm motile sperm motility. P< .05.
Gode. Microchip and density gradient methods. Fertil Steril 2019. Gode. Microchip and density gradient methods. Fertil Steril 2019.

VOL. 112 NO. 5 / NOVEMBER 2019 845

ORIGINAL ARTICLE: ANDROLOGY
recovery of motile sperm count. In a recent randomized
controlled trial (22), the gradient technique was superior to
the swim-up technique for improving clinical outcomes.
There is little information about microfluid sperm sorting.
In one previous study (23), the progressive motility of the
sperm sample was significantly higher (100%) after micro-
fluid processing than after density gradient centrifugation
with swim-up (91%) in split semen samples from the same pa-
tients. Our study confirms this result. Although the basal total
motile sperm number was higher in the density gradient
group in our study, this difference disappeared after the sperm
were prepared. In addition, motility was significantly higher
in the microchip group after preparation. Another interesting
finding in our study was higher sperm concentration in den-
sity gradient group, which can be attributed to a higher selec-
tivity of microfluidic sorting system leading to a decrement of
concentration. This negative impact seems to be balanced
with a higher motility of sperm sample after preparation in
the microfluidic sperm sorting group. Therefore, the micro-
fluidic system appears to be more advantageous when select-
ing motile sperm.
Motile sperm count is important; however, sperm
morphology, function, and DNA integrity are also being
emphasized (24, 25). Lower DNA integrity is correlated with
abnormal sperm parameters, including oligozoospermia,
teratospermia, and asthenospermia (26). Higher DNA
fragmentation rates have been detected even in
normozoospermic men of unexplained infertile couples
undergoing IUI (27, 28). Sperm DNA damage is correlated
with a lower probability of achieving a pregnancy and a
prolonged time to pregnancy for natural and IUI cycles (25,
29–32). Bungum et al. (30) reported that clinical PRs and
delivery rates are significantly lower for couples with a
DNA fragmentation index >30%. Duran et al. (31)
investigated the predictive factors for IUI outcome in a
prospective cohort study. No samples with >12% DNA
fragmentation resulted in pregnancy. They concluded that
the age of the woman/man and sperm DNA quality were the
only parameters useful for predicting IUI outcome. Muriel
et al. (33) reported that sperm chromatin dispersion is
negatively correlated with sperm motility in ejaculated and
processed sperm, but correlated with pregnancy outcome.
Nevertheless, most studies (25) support the relationship
between sperm DNA fragmentation and decreased PRs in
natural conception and IUI cycles.
The role of the sperm preparation technique in DNA frag-
mentation rates and the success of IUI cycles is controversial.
Amiri et al. (34) reported higher levels of DNA fragmentation
in swim-up than in density gradient samples. Jayaraman et al.
(35) found no significant differences in the rates of apoptotic
sperm recovered by density gradient and swim-up processing
methods. Interestingly, both swim-up and density gradient
improve DNA fragmentation in teratozoospermic semen sam-
ples (36).
Conventional sperm preparation techniques involving
the density gradient technique depend on sedimentation
and migration approaches to separate spermatozoa, which
exposes the sperm to DNA damaging reactive oxygen species
(37). However, microfluid sorting of unprocessed sperm
846
allows highly motile sperm to be selected with nearly unde-
tectable levels of DNA fragmentation compared with centri-
fugation and swim-up methods (23, 38). In our study there
was remarkable difference for a higher ongoing PR (15% vs.
9%) in the microchip group. Thus, the miscarriage rate
tended to be higher in the density gradient group (5 vs.
0 patients in the density gradient and the microchip groups,
respectively). Therefore, the microfluiding sperm sorting
method might be beneficial for reducing miscarriage rates.
However, these findings are insufficient to make a definite
conclusion on the subject.
The main limitation of this study is its retrospective
design. A randomized controlled trial is the gold standard to
compare a new treatment with the standard treatment. How-
ever, our data come from an observational study and the pre-
diction for the effect of microhip could be biased due to
confounding factors. When the basal parameters were evalu-
ated, the number of previous IUI cycles was significantly
higher and the basal total motile sperm count was signifi-
cantly lower in the microchip group. These factors may
have affected the clinical pregnancy results in the microchip
group. Because microfluid sperm sorting was preferred mostly
after a failed IUI cycle that group included patients who had a
poorer prognosis than in the density gradient group.
Conversely, the ongoing PRs and motile sperm recovery rates
were better in the microchip group than in the density
gradient group.
In conclusion, the microfluid sperm sorting method
improved motile sperm rates and ongoing PRs. Although
the PRs were similar between the two groups, there was a sig-
nificant increase in the ongoing PRs in the microchip group.
Randomized controlled studies are needed to clarify the ef-
fects of microfluid sperm sorting on clinical results in patients
undergoing ART.
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ORIGINAL ARTICLE: ANDROLOGY

Comparacion de los metodos chips de microfluidos de selecci

on esperm
atica y gradientes de densidad para uso en ciclos de
inseminacion intrauterina.
Objetivo: Comparar el efecto de los metodos chip de microfluidos de selecci
on espermatica y gradiente de densidad sobre las tasas de
gestaci
on (PRs) en pacientes que realizan inseminaci
on intrauterina (IUI).
~o: Estudio retrospectivo de cohorte.
Disen
Ubicacion: Unidad FIV hospitalaria.
Paciente(s): Parejas con infertilidad que realizan ciclos de IUI entre 2017 y 2018.
Intervencion(es): No aplicable.
Principal(es) Medida(s) de resultado(s): PRs clínica.
Resultado(s): Un total de 265 pacientes fueron incluidas en el estudio. Se uso el chip de microfluidos para seleccion espermatica y el
gradiente de densidad para preparar el semen en 133 y 132 pacientes, respectivamente. Los parametros basales del seminograma, in-
cluyendo volumen, concentraci on, motilidad y morfología, fueron similares entre los dos grupos. El conteo de movilidad total de es-
permatozoides fue menor en el grupo de selecci on espermatica por microfluidos (35.96
37.69 vs. 70.66
61.65). Despues de la
preparacion del semen la motilidad espermatica fue mayor en el grupo del microfluido (96.34
7.29 vs. 84.42
10.87). Las tasas
de gestacion fueron de 18.04% en el grupo del microfluido y de 15.15% en el grupo de gradiente de densidad, y la PRs clínica fueron
15.03% y 9.09%, respectivamente. Despues de realizar una regresi
on logística multivariable y controlar los factores de confusi
on, hubo
un incremento significativo de las PRs en el grupo de seleccion espermatica microfluídica. Las odds ratio ajustadas para la gestaci on
clínica en el grupo del microfluido comparado con el grupo de gradiente de densidad fue 3.49 (intervalo de confianza 95% 1.12-10.89).
Conclusion(es): El metodo de seleccion espermatica por microfluidosi ncrementa significativamente las tasas de gestaci
on clínica
comparado con el grupo de gradiente de densidad en ciclos IUI.

848 VOL. 112 NO. 5 / NOVEMBER 2019

 Fertility and Sterility®

SUPPLEMENTAL FIGURE 1 SUPPLEMENTAL FIGURE 2

Waterfall plot for changes in sperm concentration. Waterfall plot for changes in total motile sperm count.
Gode. Microchip and density gradient methods. Fertil Steril 2019. Gode. Microchip and density gradient methods. Fertil Steril 2019.

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