IMSI: six years of practice

Introduction: MSOME (Motile Sperm Organellar Morphology Examination) is a new method for real-time evaluation of sperm morphology under 6600x high magnification. ICSI modified procedure with sperm selected by MSOME is named IMSI (Intracytoplasmic Morphologically Selected sperm Injection). IMSI has been developed to improve ongoing pregnancy rate in couples with repeated implantation failure. Material and methods: The study concern an observational cohort of 11535 ICSI performed with fresh ejaculated sperm in our ART lab between January 2004 and July 2009. Among them, 2509 were realized with IMSI. The primary outcome measures were cleavage rate per injected oocyte on day 2, clinical pregnancy and abortion rates. Comparisons were performed using Chi square (2) test and univariate analysis of variance. Results: There were no significant difference between conventional ICSI and IMSI groups in term of cleavage and pregnancy rates. Couples with abnormal sperm (teratozoospermia, oligozoospermia and oligoteratozoospermia) and no previous ICSI failure, had a significantly higher clinical pregnancy with IMSI than with ICSI (34.4% vs. 27.1%, p = 0.02). Furthermore, pregnancies obtained in patients with teratozoospermia were associated with a lower abortion rate after IMSI than after ICSI, close to significance (12.6% vs. 19.6%, p = 0.08). Conclusion: In cases of severe teratozoospermia, IMSI appears to improve pregnancy rate and pregnancy outcome.