Intracytoplasmic Morphologically Selected Sperm Injection Research Articles

#281 : IVF Outcome of Good Prognosis Patients Based on Sperm Morphology Grading Using Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) Technique

Background and Aims: Spermatozoa morphology is one of the factors that can influence the success of IVF. IMSI is a technique that provides various selection criteria of sperm head’s morphology and the presence of vacuoles with a total magnification of over 6,000. The purpose of this study was to compare the embryo development of good prognosis patients based on sperm morphology grading using IMSI technique. Method: This study was a retrospective analysis performed at Morula IVF Jakarta from 2019 to 2022 based on good prognosis patients (age [Formula: see text] 38 years, AFC [Formula: see text] 7, AMH [Formula: see text] 1.1). There were two groups in this study, (A) sperm grade I and II, (B) sperm grade III and IV, based on Vanderzwalden et al. (2008). The number of patients in group (A) was 1035 patients, and group (B) was 345 patients. The parameters observed in this study were fertilization rate (FR), top embryo quality rate on day 3 (D3) and day 5 (D5), blastocyst rate (BR). Results: The result study showed that (FR) were significantly increased (P=0.000) in group (A) compared to group (B), which was 77.28% and 72.90%. In addition, group (A) had significantly (D3), which was 51.37% (P=0.012) compared to group (B) 46.92%. On the other hand (D5) and (BR) were significantly increased (P=0.000) in group (A), by about 42.58% and 48.01%, contrasted to group (B), which was only 36.11% and 39.21%. Conclusion: Grade I and II sperm of IMSI technique significantly increased IVF outcome in good prognosis patient.

Impact of intracytoplasmic morphologically selected sperm injection versus intracytoplasmic sperm injection on in vitro fertilization outcome in cases of poor sperm morphology or sperm deoxyribonucleic acid damage

This study airms to asses intracytoplasmic morphologically selected sperm injection (IMSI) compared to intracytoplasmic sperm injection (ICSI) in cases of male factor infertility. This article compares IMSI and ICSI in patients with poor sperm morphology or a raised deoxyribonucleic acid (DNA) fragmentation index. After meeting the inclusion criteria, 134 couples were included in the study and randomized into two groups: in vitro fertilization (IVF)-ICSI and IVF-IMSI. The results showed a higher fertilization rate (77.2 vs 54.04%) and a higher quality embryo rate (61.2 vs 40.9%) in IMSI cycles compared to ICSI cycles, and these differences were statistically significant (P value 0.009). IMSI has shown better fertilization rates compared to ICSI in patients with poor morphology. The difference in biochemical pregnancy rates (56.72 vs 34.3%) between the two groups was statistically significant (P value 0.009). This study concluded that IMSI had a higher likelihood of resulting in pregnancy in couples with male factor infertility..

The effect of azoospermia factor microdeletions on intracytoplasmic sperm injection results in azoospermia patients.

Y chromosome abnormalities are common in male patients with severe oligo-azoospermia. In studies with karyotype analysis and cytogenetic methods, the importance of the Y chromosome in spermatogenesis has been well understood. Deletions in the azoospermia factor (AZF) localized at the distal end of the Y chromosome adversely affect the spermatogenesis process. Our objective was to determine the frequency of AZF microdeletion in azoospermia patients who underwent microTESE. In this retrospective cohort study, 806 azoospermic men attending the In Vitro Fertilization (IVF) Center for infertility treatment between 2010 and 2022 were included. AZF deletion screening was conducted in all patients included in the study. Azoospermic patients with and without Y microdeletion were matched with the female's age, cause of infertility, number of oocytes retrieved and number of metaphase II (MII) oocytes produced and compared. The primary outcome was the live birth rate (LBR). Pregnancy rate (PR) and clinical pregnancy rates (CPR) were secondary outcomes. We detected Y microdeletion in 55 (6.82%) of 806 infertile azoospermic men and 35 of them included in the study. Although the required gonadotropin dose and the total number of retrieved oocytes were similar, clinical pregnancy rates and live birth rates were found to be significantly lower in the microdeletion patient group (21.6% vs. 43%, p<0.05; and 18.9% vs. 36%, p<0.05, respectively). Poor sperm quality in AZF microdeletion patients complicates the selection of appropriate sperm for ICSI. Therefore, it leads to a decrease in embryonic development, fertilization and pregnancy results. In order to select the best sperm for the use in ICSI procedure in this patient population, intracytoplasmic morphologically selected sperm injection (IMSI) method can be preferred to improve the cycle outcomes.

P-093 A comparison of the effects of IMSI and HOST for sperm selection on morphokinetic parameters and ploidy status in sibling embryos

Abstract Study question Are hypo-osmotic swelling test (HOST) and intracytoplasmic morphologically selected sperm injection (IMSI) both effective alternative methods for sperm selection? Summary answer Similar results were obtained in embryo morphokinetics between HOST and IMSI. What is known already HOST is a simple, low-cost and rapid test based on the swelling of the tail of the sperm in a hypoosmotic environment. Less DNA fragmentation, membrane integrity and aneuploidy rates have been found in sperm selected by the HOST method. It also allows identification of viable sperm in a totally immotile sperm sample. IMSI, on the other hand, is a method for identifying the morphologically best sperm using high-magnification microscope. In studies, IMSI has been associated with high fertilization rates. However, it is a time-consuming method that requires expensive equipment. Study design, size, duration Time-Lapse Monitoring (TLM)-incubated sibling embryos of 25 male factor patients who applied for ART treatment to Istanbul, Sisli Memorial ART and Genetics Center in 2021 were included into the study. Sibling embryos were grouped according to their sperm selection method. In the IMSI group 170 embryos, in the HOST group 173 embryos were evaluated retrospectively in terms of the morphokinetic parameters, the rates of blastulation, Top- Quality (TQ) and Good Quality (GQ) embryos and euploidy. Participants/materials, setting, methods Blastocyst grading was performed according to Gardner’s classification. Blastocysts 3AA,4AA,4AB,4BA,4BB,5AA,5AB,5BA,5BB were accepted as TQ+GQ. Blastulation rates was determined including the embryos at least 2 expansion. PGT-A results were obtained by Next Generation Sequencing(NGS) method. The comparison of the TLM parameters and clinical features of the patients were performed using Student’s t-test. Chi-square test was used for comparing the rates of fertilization, blastulation, TQ+GQ embryo and euploidy in each group. Main results and the role of chance No statistical difference was observed between IMSI and HOST groups in terms of morphokinetic parameters (tPN, tPNf, t2, t3, t4, t5, t6, t7, t8, t9, tSC, tM, tSB, tB, tEB) (p &amp;gt; 0.05). There were higher rates of normal fertilization in the HOST group (90.8%) than in the IMSI group (82.4%) and of TQ+GQ embryo (HOST: 50%, IMSI: 47.3%). However, these diffrences were not statistically significant (p &amp;gt; 0.05). There was statistically lower abnormal fertilization rate was found in HOST group (2.3% vs 7.1%, p = 0.038). When PGT-A results were compared (HOST:19 embryos, IMSI: 19), slightly higher results were observed in IMSI group than HOST group ( 63%, 58% respectively) (p &amp;gt; 0.05). Limitations, reasons for caution This was a retrospective of a small number of cases. Wider implications of the findings The similarity of the outcome in these initial findings studying a small number of cases, suggest that this study should be extended. Trial registration number None

Globozoospermia: A Case Report and Systematic Review of Literature.

Globozoospermia is a genetic syndrome characterized by the presence of round-headed spermatozoa and infertility due to the inability of these spermatozoa to fertilize the oocyte. In this article, we present the clinical case of a young globozoospermic patient with a new, not yet described mutation of the DPY19L2 gene. We also performed a systematic review of the literature on gene mutations, the outcome of assisted reproductive techniques, and the risk of transmission of abnormalities to the offspring in patients with globozoospermia and made recommendations to offer a more appropriate clinical management of these patients. We performed a systematic search in the PubMed, Google Scholar, and Scopus databases from their inception to December 2021. The search strategy included the combination of the following Medical Subjects Headings (MeSH) terms and keywords: "globozoospermia", "round-headed spermatozoa", "round head spermatozoa", "intracytoplasmic sperm injection", "ICSI", "offspring", "child health", "assisted reproductive technique outcome". All the eligible studies were selected following the PECOS (Population, Exposure, Comparison/Comparator, Outcomes, Study design) model. The quality of included studies was assessed by applying the "Cambridge Quality Checklists". The main genes involved in the pathogenesis of globozoospermia are DPY19L2, SPATA16, PICK1, GGN, SPACA1, ZPBP, CCDC62, and CCNB3 genes. Other genes could also play a role. These include C2CD6, C7orf61, CCIN, DNH17, DNH6, PIWIL4, and CHPT1. Globozoospermic patients should undergo ART to achieve fertility. In particular, intracytoplasmic sperm injection with assisted oocyte activation or intracytoplasmic morphologically-selected sperm injection appears to be associated with a higher success rate. Patients with globozoospermia should also be evaluated for the high rate of sperm aneuploidy which appears to influence the success rate of ART but does not appear to be associated with an increased risk of transmission of genetic abnormalities to offspring. This systematic review summarizes the evidence on the gene panel to be evaluated, ICSI outcomes, and the health of the offspring in patients with globozoospermia. Evidence-based recommendations on the management of patients with globozoospermia are provided.

Risk Assessment of the Increased Occurrence of Congenital Cardiac and Non-Cardiac Defects in Fetuses with a Normal Karyotype after Assisted Fertilization in Comparison to Natural Fertilization Based on Ultrasound Diagnostics.

The goal of the study was to assess changes in parameters based on ultrasound examinations—these were Crown Rump Length (CRL), Nuchal Translucency (NT), Fetal Heart Rate (FHR), and Pulsatility Index for Ductus Venosus (DV-PI)—in the first trimester of pregnancy in women in which there was a natural initiation of the pregnancy due to spontaneous ovulation, women in which the pregnancy was initiated as a result of stimulated ovulation, as well as in the group in which pregnancy was achieved through the use of In-Vitro Fertilization (IVF)-assisted reproduction. A total of 1581 women became pregnant without the use of assisted reproduction methods. Out of 283 pregnancies, in 178 patients, induced ovulation was utilized. Next, 137 women had sexual intercourse and became pregnant; 41 of them became pregnant through Intrauterine Insemination (IUI) as a result of Artificial Insemination by Husband (AIH), and 13 became pregnant after Artificial Insemination by Donor (AID). The third group consisted of 105 women subjected to Controlled Ovarian Hyperstimulation (COH). In this group of pregnant women, 53 pregnancies were resultant of Intracytoplasmic Sperm Injection (ICSI), and 52 pregnancies were the result of Intracytoplasmic Morphologically selected Sperm Injection (IMSI). The obtained results did not indicate that the chosen method of fertilization or the chosen ovulation method had a statistically significant effect on the development risk of congenital heart or non-heart defects in the fetus.

An Open Prospective Study on Whether Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) Offers a Better Outcome Than Conventional Intracytoplasmic Sperm Injection (ICSI).

ObjectiveTo differentiate the in vitro fertilization (IVF) outcomes between the two procedures, intracytoplasmic morphologically selected sperm injection (IMSI) and intracytoplasmic sperm injection (ICSI) in terms of relation to chemical pregnancy percentage, clinical pregnancy, live birth, miscarriage, and fertilization rates, respectively.Patients and methodsThis Open Prospective clinical trial was conducted during the period between Jan 2016 and Dec 2017 at one IVF unit. A total of 446 ICSI cycles and 79 IMSI cycles were conducted. Females were divided into four subgroups according to age.ResultsThe study involved 525 couples (446 first trial ICSI cycles) and (79 first trial IMSI cycles). ICSI was statistically better than the IMSI in relation to the chemical pregnancy, clinical pregnancy (CPR), live birth (LBR), and fertilization rates, respectively (p < 0.05). However, there were no statistically significant differences between the ICSI and IMSI in relation to the miscarriage rate. There were statistically significant differences favoring ICSI in all subgroups except 35-37, in relation to chemical pregnancy; and in the 38-40 and >40 subgroups in relation to CPR. There were no statistically significant differences in these subgroups regarding the live birth, miscarriage, or fertilization rates.ConclusionsThis study showed that IMSI is not superior to conventional ICSI at the first attempt. Based on the findings in this study, we would not advise couples to choose IMSI at their first treatment attempt.

MP31-04 DOES INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION IMPROVE LIVE BIRTH RATES COMPARED TO ICSI IN MEN WITH INFERTILITY AND RAISED SPERM DNA FRAGMENTATION?

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-04 DOES INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION IMPROVE LIVE BIRTH RATES COMPARED TO ICSI IN MEN WITH INFERTILITY AND RAISED SPERM DNA FRAGMENTATION? Runzhi Chen, Tharu Tharakan, Channa Jayasena, Sheena Lewis, Jaya Parikh, Meen-Yau Thum, James Nicopoullos, Tet Yap, and Suks Minhas Runzhi ChenRunzhi Chen More articles by this author , Tharu TharakanTharu Tharakan More articles by this author , Channa JayasenaChanna Jayasena More articles by this author , Sheena LewisSheena Lewis More articles by this author , Jaya ParikhJaya Parikh More articles by this author , Meen-Yau ThumMeen-Yau Thum More articles by this author , James NicopoullosJames Nicopoullos More articles by this author , Tet YapTet Yap More articles by this author , and Suks MinhasSuks Minhas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is conflicting evidence on the role of intracytoplasmic morphologically selected sperm injection (IMSI) in assisted reproductive technology (ART), and whether it increases live birth rates (LBR) compared to conventional intracytoplasmic sperm injection (ICSI). In particular, the role of IMSI on ART outcomes in infertile men with raised sperm DNA fragmentation (SDF) is controversial. METHODS: We performed a retrospective analysis of 2,693 ICSI and 765 IMSI cycles from a single institution. Primary outcome measures included fertilisation rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rates (LBR). Subgroup analysis was performed on couples who had undergone SDF testing with the Comet assay. Multiple regression analysis was performed to identify variables which may predict LBR in both the overall cohort of patients, and in the subgroup of patients with SDF data. An average Comet score (ACS) of ≥29% was used as the threshold for elevation, as previously defined. RESULTS: The LBR was comparable between ICSI and IMSI cycles in the overall study population; 18.1% and 21.0%, respectively. Subgroup analysis of men with a raised SDF (Table 1) demonstrated a lower MR (40.9% vs. 88.9%, p=0.003) and higher LBR (17.5% vs. 3.2%, p=0.003) in IMSI compared to ICSI cycles. No differences in clinical outcomes were observed between IMSI and ICSI cycles in men with a normal SDF. Multiple regression analysis revealed that IMSI significantly increased the probability of LBR (OR 7.052 [95% CI 1.826–27.237], p=0.005) in men with raised SDF. . . CONCLUSIONS: This study indicates that whilst IMSI may not be beneficial in the general infertile male population undergoing ART, it does improve LBR in men with raised SDF and male factor infertility. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e556-e556 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Runzhi Chen More articles by this author Tharu Tharakan More articles by this author Channa Jayasena More articles by this author Sheena Lewis More articles by this author Jaya Parikh More articles by this author Meen-Yau Thum More articles by this author James Nicopoullos More articles by this author Tet Yap More articles by this author Suks Minhas More articles by this author Expand All Advertisement Loading ...

THE EFFICACY OF PHYSIOLOGICAL SPERM SORTING IN ADDITION TO MORPHOLOGICAL SORTING

Selection of spermatozoa is one of the most important factors that influence embryonic development and clinical outcome in intracytoplasmic sperm injection (ICSI). Intracytoplasmic morphologically selected sperm injection (IMSI) is a technique that selects spermatozoa only according to their morphologically features under high magnification. However, there is another sperm selection technique that uses hyaluronic acid (HA) to select physiologically mature spermatozoa (HA-ICSI). The purpose of this study is to investigate the efficacy of physiological sperm sorting in addition to morphological sorting, and how this could contributes to subsequent embryonic development and clinical outcomes. Study 1: A total of 658 mature (MII) oocytes derived from large follicles obtained under letrozole cycle were enrolled between April 2017 and May 2020. Sperm sorting using HA was performed with SpermSlow™ (ORIGIO). The normal fertilization rates, abnormal fertilization rates, egg degeneration rates, cleavage rates, blastocyst formation rates, blastocyst freezing rates, and good quality blastocyst rates at freezing were compared between the two groups (339 oocytes in the IMSI group (April 2017 to April 2018) and 319 oocytes in the HA-IMSI group (April 2018 to May 2020)). Study 2: Clinical pregnancy rates (CPR), live birth rates (LBR), and abortion rates of day 2 fresh cleavage stage embryo transfer (d2ET) were compared between the IMSI group and the HA-IMSI group. A total of 128 patients (age 34–40 years) out of 225 patients (age 37.1± 4.1 years ) who underwent d2ET of their first treatment cycle between January 2017 and December 2019 were enrolled. Written informed consent was obtained from all participants. Study 1: The blastocyst freezing rates of participants that were <40 years of age was significantly higher in the HA-IMSI group (73.3% vs. 58.0%, p<0.05) than in the IMSI group. The rates of egg degeneration of participants that were >40 years of age was significantly lower in the HA-IMSI group (0.7% vs. 5.2%, p<0.05) that in the IMSI group. Other parameters also showed favorable trends in the HA-IMSI group, but were not statistically significant. Study 2: The CPR and LBR were significantly higher in the HA-IMSI group (18.2% vs 34.2%, p<0.05 14.6% vs 32.9%, p<0.05 respectively) than in the IMSI group. There was no significant differences in abortion rates. Blastocyst freezing rates in participants that were <40 years of age was significantly higher in the HA-IMSI group than in the IMSI group, and this suggests that the effect of physiological sperm sorting using HA is more remarkable when the quality of the oocyte is guaranteed.

Impact of Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) on Birth Defects: A Systematic Review and Meta-Analysis.

Objective:It is generally accepted that the incidence of birth defects in spontaneously conceived children ranges between 2.0-4.0%. However, several studies have shown that babies born after assisted reproductive technology (ART) procedures tend to present more congenital malformations than naturally conceived children, with 6.5% of the children born after intracytoplasmic sperm injection (ICSI) presenting birth defects. The use of high magnification sperm selection before ICSI was introduced in the early 2000s to allow the identification of spermatozoa with low risk of sperm DNA damage. Intracytoplasmic morphologically selected sperm injection (IMSI) is expected to change the incidence of congenital malformations, although data on the incidence of birth defects in children conceived after IMSI are still scarce.Methods:A systematic review based on searches performed in electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials) including articles published by February 2021 was conducted to identify trials comparing the neonatal outcomes of ICSI and IMSI. The outcome measured was the rate of birth defects in children born after ICSI or IMSI. Three trials were included as targets for data extraction and meta-analysis.Results:Our meta-analysis included 3907 children conceived after IMSI (1280) or ICSI (2627). The incidence of birth defects was statistically different, with 2.5% (32/1280) in IMSI and 4.5% (119/2627) in ICSI (RR=0.59; 95% CI=0.40-0.87; p=0.007). The results demonstrated that IMSI decreased the incidence of structural defects compared to ICSI - 2.2% (18/830) vs. 3.8% (78/2049) - in a statistically significant manner (RR=0.58; 95%CI=0.35-0.96; p=0.04). No significant difference was observed in chromosomal abnormalities (Trisomy 13; 18; 21 and Triple X) between children conceived after IMSI (8/830) or ICSI (19/2049) (RR=1.07; 95%CI=0.47-2.43; p=0.87).Conclusions:IMSI seems to be an effective tool at reducing the incidence of structural defects compared to ICSI. However, IMSI does not change the incidence of chromosomal abnormalities.

The possibility of integrating motile sperm organelle morphology examination (MSOME) with intracytoplasmic morphologically-selected sperm injection (IMSI) when treating couples with unexplained infertility.

To examine the efficacy of motile sperm organelle morphology examination (MSOME) and intracytoplasmic morphologically-selected sperm injection (IMSI) for unexplained infertility. This historical study, included 271 couples with primary, unexplained infertility/male subfertility, treated at an outpatient, IVF clinic, 2015-2018. These couples underwent MSOME after ≥3 failed intrauterine insemination (IUI) cycles and ≥1 failed IVF-ICSI cycle. They proceeded to intracytoplasmic morphologically-selected sperm injection (IMSI) within 6 months of MSOME. IMSI is conducted on the day of oocyte pick-up with a fresh semen sample. Pregnancy and delivery rates were analyzed. The cohort was divided based on percentage of normal cells at MSOME: Group A included 55 with no normal cells, Group B, 184 with 0.5%≤ normal cells ≤1.5% and Group C, 32 with ≥2% normal cells. Normal spermatozoa were found in 49 (89%) of Group A after extensive search. Group A had higher pregnancy rate (62.7%) compared to B (47.2%, P = 0.05) and C (28.1%, P = 0.002). Group B had higher pregnancy rate than C (p = 0.045). Delivery rate was higher in Group A (52.1%) compared to B (34.1%, p = 0.023) and C (21.9%, p = 0.007). Pregnancy and delivery rates were higher in A compared to B+C (p = 0.018, p = 0.01, respectively). MSOME may be useful for evaluating unexplained infertility. IMSI can be recommended for men with <2% normal spermatozoa at MSOME.

For couples undergoing assisted reproductive technology (ART), how does ultra-high magnification intracytoplasmic morphologically selected sperm injection (IMSI) compare with intracytoplasmic sperm injection (ICSI)?

For couples undergoing assisted reproductive technology (ART), how does ultra-high magnification intracytoplasmic morphologically selected sperm injection (IMSI) compare with intracytoplasmic sperm injection (ICSI)?

Regular (ICSI) versus ultra-high magnification (IMSI) sperm selection for assisted reproduction.

Subfertility is a condition found in up to 15% of couples of reproductive age. Gamete micromanipulation, such as intracytoplasmic sperm injection (ICSI), is very useful for treating couples with compromised sperm parameters. An alternative method of sperm selection has been described; the spermatozoa are selected under high magnification (over 6000x) and used for ICSI. This technique, named intracytoplasmic morphologically selected sperm injection (IMSI), has a theoretical potential to improve reproductive outcomes among couples undergoing assisted reproduction techniques (ART). However, our previous version of this Cochrane Review was unable to find evidence that supported this possible beneficial effect. This is an update of Teixeira 2013. To identify, appraise, and summarise the available evidence regarding efficacy and safety of IMSI compared to ICSI in couples undergoing ART. We searched for randomised controlled trials (RCTs) in these electronic databases: the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, and in these trial registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We also handsearched the reference lists of included studies and similar reviews. We performed the last electronic search on 18 November 2019. We only considered RCTs that compared ICSI and IMSI; we did not include quasi-randomised trials. We considered studies that permitted the inclusion of the same participant more than once (cross-over or per cycle trials) only if data regarding the first treatment of each participant were available. Two review authors independently performed study selection, data extraction, and assessment of the risk of bias and quality of the evidence; we solved disagreements by consulting a third review author. We corresponded with study investigators to resolve any queries, as required. The updated search retrieved 535 records; we included 13 parallel-designed RCTs comparing IMSI and ICSI (four studies were added since the previous version), comprising 2775 couples (IMSI = 1256; ICSI = 1519). We are uncertain if IMSI improves live birth rates (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.89 to 1.39; 5 studies, 929 couples; I² = 1%), miscarriage rates per couple (RR 1.07, 95% CI 0.78 to 1.48; 10 studies, 2297 couples; I² = 0%, very-low quality evidence), and miscarriage rate per pregnancy (RR 0.90, 95% CI 0.68 to 1.20; 10 studies, 783 couples; I² = 0%, very-low quality evidence). We are uncertain if IMSI improves clinical pregnancy rates (RR 1.23, 95% CI 1.11 to 1.37; 13 studies, 2775 couples; I² = 47%, very-low quality evidence). None of the included studies reported congenital abnormalities. We judged the evidence for all outcomes to be of very low-quality. We downgraded the quality of the evidence due to limitations of the included studies (risk of bias), inconsistency of results, and a strong indication of publication bias. The current evidence from randomised controlled trials does not support or refute the clinical use of intracytoplasmic sperm injection (intracytoplasmic morphologically selected sperm injection (IMSI). We are very uncertain of the chances of having a live birth and of the risk of having a miscarriage. We found very low-quality evidence that IMSI may increase chances of a clinical pregnancy, which means that we are still very uncertain about any real difference. We did not find any trials reporting on the risk of congenital abnormalities. Well-designed and sufficiently powered trials are still required.

MSOME and IMSI: reasonable rationale, selective clinical value

Purpose: Motile sperm organelle morphology examination (MSOME) is a real-time high magnification motile sperm examination applied prior to intracytoplasmic morphologically selected sperm injection (IMSI) - intracytoplasmic injection of the selected spermatozoon. Over the past decade, there is an important shift concerning MSOME, focusing on the shape of the sperm head and presence of vacuoles, resulting with different selection criteria. The authors investigated the relevance of sperm vacuoles phenomenon. From a clinical perspective they focused on prospective trials aiming to distinguish scenarios in which IMSI may improve clinical outcome compared with intracytoplasmic sperm injection (ICSI). Materials and Methods: The authors performed this review based on a primary literature search of publications, which as of November 1, 2017, were listed in PubMed under the search phrase &lt;motile-sperm organelle morphology examination&gt;, &lt;MSOME&gt;, &lt;intra-cytoplasmic morphologically selected sperm injection&gt;, &lt;IMSI&gt;, and &lt;sperm vacuoles&gt;. The references of these manuscripts were further reviewed when considered relevant to the subject. Results: Inadequate chromatin compaction leads to higher rate of DNA fragmentation and aneuploidies, which may be followed by the appearance of large vacuoles. Distinguishing between large and small vacuoles remains a challenge. IMSI may expand blastocyst formation in cases of previous embryos developmental arrest and may be used in cases of isolated teratospermia and repetitive ICSI cycles failures. Conclusions: Solid evidence supports the association between non-adequate sperm DNA compaction and DNA defects, resulting with abnormal vacuoles. Current prospective studies emphasize ICSI as first treatment for male factor during assisted reproductive technology (ART), while the role of IMSI in selective clinical scenarios warrants further large randomized controlled studies.

Intracytoplasmic morphologically selected sperm injection, but for whom?

Intracytoplasmic sperm injection (ICSI) is performed in cases of infertility by injecting a motile and morphologically normal sperm cell under a routine ×400 magnification at which is hard to distinguish morphologically healthy sperm. Recently, the use of high-powered differential interference contrast optics gave the opportunity to select a sperm under ultra-high magnification of ×10,160. The aim of the present study was to evaluate the efficacy of the intracytoplasmic morphologically selected sperm injection (IMSI) technique in different infertility populations undergoing ICSI. Main outcome measures of routine ICSI were compared with IMSI in three different groups of patients (1, non-selected; 2, male infertility; and 3, repeated implantation failure group). Results were analysed to evaluate the effects of the IMSI procedure and to find the most suitable group of patients who may benefit from the procedure. IMSI caused a significant increase in the fertilization and top quality embryo rates in the male infertility group and a significant increase in fertilization and pregnancy rates in the repeated implantation failure group, whereas no effect was observed in the non-selected group with patients of various indications. A positive effect of IMSI on the outcome of male factor infertility and repeated implantation failure patients was observed. Data observed confirmed that the application of IMSI was beneficial for a selected group of patients with male factor infertility and repeated implantation failure.

Advanced sperm selection techniques for assisted reproduction.

Advanced sperm selection techniques for assisted reproduction.

Which semen analysis correlates with favorable Intracytoplasmic morphologically selected sperm injection (IMSI) outcomes?

ObjectiveTo assess whether a correlation exists between different sperm pathologies and Intracytoplasmic morphologically selected sperm injection (IMSI) outcomes. Study designA retrospective cohort study which included couples with recurrent implantation failures (2 or more unsuccessful IVF-ICSI cycles) undergoing their first IVF-IMSI cycle in Hebrew-University Hadassah Medical Center between January 2008 and May 2017. ResultsA total of 170 couples with at least two IVF failures attempting their first IVF-IMSI cycle were included, of them 56 (32.9%) achieved a clinical pregnancy. No correlation was found between clinical pregnancy and a specific abnormal semen parameter. However, a positive correlation with clinical pregnancy was demonstrated when all three semen parameters were abnormal (OR-3.33, p = 0.015). ConclusionsOur findings suggest that IMSI procedure may be more efficient in severe compound sperm pathologies than in patients with one abnormal sperm parameter. Future prospective trials are required to reinforce these findings and allow formation of clear indications for IMSI.

The use of capillary-cumulus oophorus model for evaluating spermatozoa selection by intracytoplasmic morphologically selected sperm injection (IMSI)

The use of capillary-cumulus oophorus model for evaluating spermatozoa selection by intracytoplasmic morphologically selected sperm injection (IMSI)

Assistance médicale à la procréation : techniques actuelles et nouveaux horizons

Assisted reproductive technologies (ART) gather all the techniques allowing the first reproductive steps outside natural process, mainly represented by the intrauterine insemination, the in vitro fertilization (classical-IVF or with sperm microinjection-[ICSI]), and the frozen embryo transfer. In addition, these techniques can notably group: donor program, natural cycle, prolonged culture, IMSI (Intracytoplasmic Morphologically selected Sperm Injection) and viral risk context. The purpose of this article is to describe process and indications of the main techniques used, and to address some innovative and promising techniques such as the time-lapse system, oocyte in vitro maturation, PGS (Preimplantation Genetic Screening of Aneuploidies) which will certainly improve ART results while limiting risks of multiple pregnancy.

Impact of high magnification sperm selection on neonatal outcomes: a retrospective study

The aim of this study was to compare the effect of the deselection of spermatozoa presenting vacuole-like structures using IMSI (intracytoplasmic morphologically selected sperm injection) with ICSI (intracytoplasmic sperm injection) by means of neonatal outcomes. In a retrospective two-center analysis, a total of 848 successful IMSI or ICSI cycles ending with a live birth, induced abortion, or intrauterine fetal death (IUFD) were included. The IMSI and ICSI groups included 332 and 655 babies or fetuses, respectively. The parents were older in the IMSI group than in the ICSI group (mothers were 35.1 vs 32.9years, and fathers were 39.1 vs 36.2years). The multiple pregnancy rate was higher in the IMSI group. The mean pregnancy duration and mean birth weight were almost identical in both groups. There was no significant difference in major congenital malformations between the two groups. However, this rate was decreased in the IMSI group compared to that in the ICSI group (1.8 vs 3.2%), the difference being mainly found in singletons (1.4 vs 3.3%). Boys were more often affected than girls in both groups. The percentages of chromosomal abnormalities did not differ between the IMSI and ICSI groups (0.6 and 0.8%). The reported congenital malformations mainly affected the heart, urogenital, and musculoskeletal systems. In the present study, the malformation rates observed in the IMSI and ICSI groups were not significantly different, even if slightly lower after IMSI. However, the observed difference followed the same trends observed in previous reports, indicating the possible impact of IMSI on decreasing congenital malformation occurrences. This highlights the necessity to prospectively evaluate the impact of IMSI on neonatal outcome after IVF treatment.