MACS is a method to select a non-apoptotic sperm. Apoptotic or apoptosis-like manifestation sperm have an externalized phosphatidylserine (EPS) on sperm surface, EPS is a marker of apoptotic or apoptosis-like manifestation sperm which have a DNA damage or sperm DNA fragmentation. DNA damage will lead sperm to have programmed cell death. There are many factors that have effect to sperm DNA such as environmental and life style factors, systemic diseases, or primary cause of male reproductive tract.
Sperm with normal morphology may have some degree DNA fragmentation. sDNAfrag will affect the quality of embryos in term of low blastocyst development rate, low pregnancy rate and high miscarriage rate. In a recent year, there is a meta-analysis which study about sDNA frag and risk of miscarriage rate. They found that miscarriage rate have higher in sDNAfrag group around 2.16 times when compare with control group.
MACS has an advantage over a conventional sperm preparation (SW or DGC) in term of decrease sDNSfrag sperm, which have MMP, CP-9 and EPS, more oocyte penetration potential sperm. The advantage of MACS confirm by the recently publication, they found that sperm preparation by MACS + DGC will have more pregnancy rate around 1.5 times when compare with DGC alone.
Conclusion, sperm preparation with MACS and DGC methods will have some advantages in some couples who have several infertility treatment failure or severe abnormal sperm parameters.