Does gradients or swim up procedure produce baby of desired gender?

Abstract

Introduction Human desire to pre select baby gender has a long history and possibly existed in all cultures. 1 The reasons include; cultural, social and economic preferences, gene linked diseases and family balancing. 2 Even the infertile patients have significant demand for preimplantation sex selection, with a significant portion of this demand coming from patients who do not have any child or have all children of same sex. 3 The publication of article on separation of X-and Y-bearing spermatozoa using albumin gradients 4 gained high popularity. Later, another study 5 suggested the possibility that the swim-up technique may help preselect male offspring. The density gradient procedure is reported to concentrate X-bearing sperm in the sediment. Kaneko et al 1983 6 found that after centrifugation, the content of Y-bearing sperm in the fraction lighter than 1.06gm/ml was 73.1%±3.3% and was reduced gradually along the density increment and it was 27.4%±3.4% in the sediment (more than 1.11gm/ml). Several studies have been carried out to select desired gender of baby with conflicting results. Non-significant influence was found on the mean ratio of X-to Y-bearing spermatozoa after semen was prepared with Percoll gradients or after swim up as compared to that in fresh semen. 7,8 Before the advent of pre-implantation genetic testing (PGT), the most common laboratory procedures used for sperm separation were gradient filtration, swim up or swim down, albumin gradient filtration and sperm sorting by flow cytometry followed by IUI or ICSI. However, due to high cost of flow cytometry technique and PGT, most laboratories use either gradient or swim up procedure. The underlying concept is that swim-up technique enriches Y-bearing sperm and density-gradient separation enriches X-bearing sperm. Among the sperm separation techniques, sperm sorting by flow cytometry separated X and Y bearing sperm deviating significantly from the natural ratio of 50:50 but not 100%. The actual outcome is measured based on the delivery of desired gender as fertilization may happen by any sperm X or Y if the separation techniques is not separating at 100% level. The objectives of this study were to investigate whether swim-up; density gradient and simple wash followed by IUI result in significant deviation in the ratio of male and female babies. Materials and methods The data were collected from 990 couples undergoing IUI cycles at Thuriah Medical Center from January 2016 to December 2017. The semen was collected on site after 3-5 days abstinence and processed by gradient filtration, swim up or simple wash (Figure 1) depending on the quality of sample and gender preselection desire of patient. The gradients were prepared in 15 mL Falcon conical tube (Fisher Scientific); 1.5mL of 80 % gradient (V-Grad 80, VITROMED, Germany) at the bottom and 1.5mL of 40% gradient (V-Grad 40, VITROMED, Germany) on the top of it. The semen sample was gently layered on the top of the 40% gradient. The tube was centrifuged at 1500rpm for 20 minutes. The pellet was washed in 4mL V-Sperm Wash (VITROMED, Germany) by centrifugation at 1500rpm for 8 minutes. The final pellet was re-suspended in 0.4mL V-Sperm Wash for IUI. Abstract Background: Pre selection of baby gender is still desire of many parents. A number of procedures have been used including X and Y sperm separation by various semen processing procedures for intrauterine insemination (IUI), sperm sorting by flow-cytometry, fluorescent in situ hybridization and preimplantation genetic testing (PGT). Due to low cost, simplicity and easy availability, various X-and Y-bearing sperm separation procedures followed by IUI have been commonly used but with conflicting accuracy. The most common sperm separation procedures include; gradients filtration, swim up, swim down and albumin gradients filtration. The objective of this study was to investigate whether swim-up or density gradient semen processing followed by IUI results in significant deviation in the ratio of male and female babies.