Abstract
BackgroundThe purpose of this study was to compare laboratory and clinical outcomes of intracytoplasmic morphologically selected sperm injection (IMSI) and conventional intracytoplasmic sperm injection (ICSI) in couples with repeated implantation failures.MethodsA total of 200 couples with at least two prior unsuccessful ICSI cycles were enrolled: 100 couples were submitted to IMSI and 100 were submitted to routine ICSI. For IMSI, spermatozoa were selected at 8400× magnification using an inverted microscope equipped with Nomarski (differential interference contrast) optics. For conventional ICSI, spermatozoa were selected at 400× magnification. Clinical outcomes were evaluated between the two groups.ResultsStudy patients were comparable in age, number of treatment failures, aetiology of infertility, percentage of normal form assessed by MSOME (motile sperm organelle morphology examination), semen parameters, total number of oocytes collected, number of mature oocytes collected, total number of embryos transferred and number of high-quality embryos transferred. No statistically significant differences between the two groups were observed with regard to rates of fertilisation, implantation and pregnancy/cycle. Although not statistically significant, rates of miscarriage (IMSI:15.3% vs ICSI:31.7%), ongoing pregnancy (IMSI:22% vs ICSI:13%) and live births (IMSI:21% vs ICSI:12%) showed a trend towards better outcomes in the IMSI group. In addition, analysis of subpopulations with or without male factor showed similar results.ConclusionsOur results suggest that IMSI does not provide a significant improvement in clinical outcome compared to ICSI, at least in couples with repeated implantation failures after conventional ICSI. However, it should be noted that there were clear trends for lower miscarriage rates (≈50% reduced) and higher rates of ongoing pregnancy and live births (both nearly doubled) within the IMSI group. Further confirmation as well as randomized large-scale trials are needed to confirm the beneficial effects of IMSI in couples with poor reproductive prognoses.
Highlights
The purpose of this study was to compare laboratory and clinical outcomes of intracytoplasmic morphologically selected sperm injection (IMSI) and conventional intracytoplasmic sperm injection (ICSI) in couples with repeated implantation failures
This method led to the development of the intracytoplasmic morphologically selected sperm injection (IMSI) procedure, which is based on sperm normality as defined by motile sperm organelle morphology examination” (MSOME) classification and aims to improve conventional ICSI outcomes by focusing on the correlation between abnormalities in sperm morphology observed at high magnification and DNA damage [5,13,14,15,16,17,18,19,20]
The characteristics of the study patients in both the IMSI and ICSI groups were comparable with regard to age, the number of treatment failures, aetiology of infertility, the percentage of normal form assessed by MSOME, semen parameters, the total number of oocytes collected, the number of mature oocytes collected, the total number of embryos transferred and the number of high-quality embryos transferred
Summary
The purpose of this study was to compare laboratory and clinical outcomes of intracytoplasmic morphologically selected sperm injection (IMSI) and conventional intracytoplasmic sperm injection (ICSI) in couples with repeated implantation failures. MSOME is performed using an inverted microscope equipped with Normarski interference contrast optics, which enables observation at high magnification (> 6000×) compared to the 200400× observed by conventional ICSI [12]. This method led to the development of the intracytoplasmic morphologically selected sperm injection (IMSI) procedure, which is based on sperm normality as defined by MSOME classification and aims to improve conventional ICSI outcomes by focusing on the correlation between abnormalities in sperm morphology observed at high magnification and DNA damage [5,13,14,15,16,17,18,19,20]. Prior failures in ICSI cycles constituted an inclusion criterion in several studies employing IMSI [6,13,24,28,30]
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