P-111 Improving embryo quality in patients over 40: The role of granulosa cell-mediated sperm selection

Abstract Study question Do granulosa cells enhance sperm selection and embryo quality in advanced maternal age patients undergoing intracytoplasmic sperm injection? Summary answer Sperm selection via granulosa cells enhances embryo quality in patients over 40 years old. What is known already Numerous studies have highlighted that spermatozoa capable of traversing the oocyte’s granulosa cells exhibit enhanced motility and capacitation. For successful in vivo fertilization, sperm must penetrate the granulosa-oocyte complex, where hyaluronic acid serves as a key component. Mature sperm show an affinity for hyaluronic acid, demonstrating superior motility and facilitating the acrosome reaction. Optimising sperm selection has been shown to improve outcomes in in vitro fertilisation treatments. However, advanced maternal age adversely affects oocyte and embryo quality, leading to reduced success rates in assisted reproductive technologies (ART). Study design, size, duration A prospective randomised multicenter study was conducted between July 2022 and December 2024, analysing data from 1,097 oocytes obtained from 99 autologous oocyte treatments. Participants were divided into two groups: granulosa cells and control. Additionally, three subgroups were established based on maternal age: 26–35, 36–39, and 40–45 years. The sample size was determined to detect a 10% difference in blastocyst formation rates between the two groups. Participants/materials, setting, methods A total of 99 autologous oocyte cycles were analyzed. Sibling oocytes were randomized into study (granulosa cells, 554 oocytes) and control groups (543 oocytes). Sperm samples (10 million/ml motile spermatozoa) were prepared using the “Supersperm” ICSI dish (Oosafe® ICSI Dish with Sperm Selection Channels, CE mark pending). Fertilized oocytes were cultured in Geri dishes with 80 µL Global Total medium until day 5 and evaluated using Gardner’s criteria. Statistical analysis was performed using R (v4.4.2). Main results and the role of chance No statistically significant differences were observed between the study and control groups in fertilisation rate (74.9% vs 78.1%, p = 0.689) or blastocyst formation rate (62.8% vs 58.3%, p = 0.178), respectively. However, the study group exhibited a significantly higher proportion of good-quality embryos compared to the control group (55.2% vs 45.3%, p = 0.028). Subgroup analysis revealed no significant differences in the 26–35 age group for fertilisation rate (79.7% vs 84.3%, p = 0.529), blastocyst formation rate (66.2% vs 68.1%, p = 0.726), or good-quality embryos (60.9% vs 54.1%, p = 0.344). Similarly, in the 36–39 age group, no significant differences were found in fertilisation (73.3% vs 77.9%, p = 0.408), blastocyst formation (61.3% vs 52.9%, p = 0.137), or good-quality embryos (52.3% vs 45.1%, p = 0.334). Conversely, the 40–45 age group showed a significantly higher rate of good-quality embryos in the granulosa cell group compared to the control group (51.4% vs 30.4%, p = 0.017). However, no statistically significant differences were observed in fertilisation (70.9% vs 70.1%, p = 0.734) or blastocyst formation (59.8% vs 50.5%, p = 0.174) for this subgroup. Our data suggest that sperm selection using granulosa cells in the “Supersperm” ICSI dish could benefit patients of advanced maternal age by obtaining better quality embryos, since these oocytes have less capacity to repair sperm damage. Limitations, reasons for caution Although the results indicate promising improvements in achieving higher rates of good-quality embryos, further research is necessary to better characterise the properties of the selected spermatozoa. Wider implications of the findings Our findings suggest that sperm selection using granulosa cells may benefit patients of advanced maternal age by improving embryo quality, as oocytes from this group have a reduced ability to repair sperm damage. This method offers a simple and reliable approach during ICSI, demonstrating superior laboratory outcomes in this population. Trial registration number No