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Beneficial effects of hyaluronic acid (HA)-based selection of spermatozoa for intracytoplasmic sperm injection (ICSI) are still controversial, and further studies are needed to categorize patients that might benefit from such a method. We investigated whether HA sperm selection improved ICSI outcome of couples with previous ICSI cycle failure. In this retrospective study, we prospectively collected data of (i) Group 1 96 couples who performed one failed ICSI cycle ("1st procedure," n=96) followed by another ICSI cycle ("2nd procedure,"