Is intracytoplasmic morphologically selected sperm injection effective in patients with infertility related to teratozoospermia or repeated implantation failure

Capsule:
This prospective study suggests that intracytoplasmicmorphologically selected sperm injection is effective in patients with severe teratozoospermia but unsuccessful in patients with repeated intracytoplasmic sperm injection failure in the absence of severe male factor.

Authors:
Laïla El Khattabi, Pharm.D., Charlotte Dupont, Pharm.D., Nathalie Sermondade, M.D., Jean-Noël Hugues, M.D., Ph.D., Christophe Poncelet, M.D., Ph.D., Raphael Porcher, M.D., Ph.D., Isabelle Cedrin-Durnerin, M.D., Rachel Lévy, M.D., Ph.D., Christophe Sifer, M.D.

Volume 100, Issue 1, Pages 62-68, July 2013

Abstract:

Objective:
To evaluate the potential benefit of intracytoplasmic morphologically selected sperm injection (IMSI) in patients selected for either severe teratozoospermia or repeated implantation failure after conventional intracytoplasmic sperm injection (ICSI).

Design:
Prospective nonrandomized observational study.

Setting:
University hospital assisted reproduction unit.

Patient(s):
Four hundred seventy-eight patients were enrolled to evaluate ICSI and IMSI results for two indications. The first group (T) was composed of patients with severe teratozoospermia (<10% normal spermatozoa in fresh ejaculated and selected semen, according to David classification) and no or one previous ICSI failure. In the second group (IF), patients with at least two previous failed ICSI attempts were enrolled in absence of severe male factor (>10% normal spermatozoa in fresh ejaculated semen and >20% in selected sperm).

Intervention(s):
ICSI/IMSI, biologic, and clinical data collection.

Main Outcome Measure(s):
Live-birth rate (LBR).

Result(s):
In group T, LBR was significantly higher when IMSI procedure was used compared with ICSI (38% [50/132] vs. 20% [25/126]). However, LBR observed in group IF was not significantly different between IMSI and ICSI procedures (21% [19/90] vs. 22% [28/130]).

Conclusion(s):
IMSI procedure is a valuable option for patients with severe teratozoospermia at their first or second attempts, but it does not improve pregnancy rate in patients with repeated ICSI failures in the absence of severe male factor.

  • This study addresses the question of potential indications for IMSI prospectively. The results are interesting and suggest that in cases of teratospermia but not repeated implantation failure IMSI may be useful.
    Questions about the applicability of this study to practice are:
    1) How do the David classification criteria translate to the Kruger and WHO criteria?

    2) What are the staffing / cost implications for a busy ART laboratory when implementing changes in IMSI used based on the results of this study?

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