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Empirical In Vitro Fertilization for Recurrent Pregnancy Loss: Is It a Valid Concept?
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Michal Kirshenbaum, Raoul Orvieto
Intracytoplasmic morphologically selected sperm injection (IMSI) is a technique to select sperm for injection to the egg by examining the organelle morphology, such as the acrosome, postascrosomal lamina, neck, mitochondria, tail, and nucleus (motile sperm organelle morphology examination [MSOME]) using ultra-high magnification (≥6000×) microscopy. Although initial reports have shown that IMSI is associated with a higher pregnancy rate and lower miscarriage rate [18,19], both the effectiveness and safety of IMSI in clinical practice remain unclear. A Cochrane review has found an increased clinical pregnancy rate using IMSI compared to intracytoplasmic sperm injection (ICSI), although there was no difference regarding the live birth rate or the miscarriage rate [20].
Intracytoplasmic Sperm Injection
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Emad Fakhry, Medhat Amer, Botros Rizk
The intracytoplasmic morphologically selected sperm injection (IMSI): Sperm with large amounts of DNA damage can fertilize the oocyte and generate embryos but with poorer embryo development, and defective implantation rates. High magnification may improve sperm selection without damaging it [47]. High magnification can also exclude immature spermatozoa with expanded chromatin [48]. Oocyte microinjection of individually selected sperm (IMSI) with a strictly defined morphologically normal nuclear shape and organelle content (e.g., acrosome) resulted in better pregnancy rates compared to the conventional ICSI. IMSI is done with an inverted microscope with high-power optics and digital imaging that allows the magnification of sperm up to 6,000 times, compared to the traditional 400 times with ICSI [49].
The embryo in recurrent implantation failure
Published in Efstratios M. Kolibianakis, Christos A. Venetis, Recurrent Implantation Failure, 2019
Intracytoplasmic morphologically selected sperm injection (IMSI) could be of value to patients with RIF that have abnormal sperm parameters. Balaban et al.27 reported that patients with RIF who had IMSI experienced higher implantation and clinical pregnancy rates compared with those who had ICSI, (28.9% vs. 19.5% and 54.0% vs. 44.4%, respectively; p ≥ 0.05). El Khattabi et al.28 suggested that IMSI is beneficial for patients with severe teratozoospermia at their first or second attempts, but it does not improve the pregnancy rate in patients with repeated ICSI failures in the absence of severe male factor. In particular, these authors showed that live birth rate was significantly higher when IMSI was used in men with teratozoospermia and RIF compared with ICSI (38% [50/132] vs. 20% [25/126]) but was similar between IMSI and ICSI procedures (21% [19/90] vs. 22% [28/130]) in men with RIF and no severe male factor. Delaroche et al.29 reported that the percentage of top quality embryos at cleavage stages was higher in IMSI compared with IVF/ICSI cycles (89.8% vs. 79.8%; p = 0.009), the mean number of blastocysts was higher in IMSI cycles (1.5 ± 1.9) than in in vitro fertilization (IVF)/ICSI cycles (1.0 ± 1.2; p = 0.03), and the clinical pregnancy and live birth rates were higher in IMSI versus IVF/ICSI cycles.
Recurrent implantation failure – an overview of current research
Published in Gynecological Endocrinology, 2021
Veronika Günther, Sören v. Otte, Damaris Freytag, Nicolai Maass, Ibrahim Alkatout
Analogous to female factors, like maternal age, male factor, particularly spermatozoal morphology, may play a role in RIF. Spermatozoa can only function in a proper way, when they show smooth nuclei with normal chromatin content and have a normal head shape. Intracytoplasmic morphologically selected sperm injection (IMSI) requires examination of spermatozoa under ultra-magnification X3600 before injection into the oocyte [18]. Shalom-Paz et al. showed a higher incidence in biochemical and clinical pregnancy rate and live birth rate after the usage of IMSI [30], whereas other studies could not demonstrate any benefit of using IMSI. There is still a lack of specific microscopic criteria for the assessment of sperm morphology, and therefore more studies are required to confirm the advantages of IMSI before a standardized clinical protocol can be created for this particular procedure [31].
Sperm content of TXNDC8 reflects sperm chromatin structure, pregnancy establishment, and incidence of multiple births after ART
Published in Systems Biology in Reproductive Medicine, 2020
Peter Ahlering, Miriam Sutovsky, Douglas Gliedt, Kellie Branson, Antonio Miranda Vizuete, Peter Sutovsky
Intracytoplasmic morphologically selected sperm injection (IMSSI) procedure utilized differential interference (DIC) at 600x or Hoffman contrast at 400x to visualize imperfections in spermatozoa selected for ICSI not normally seen at 200x. Narishige hydraulic micromanipulators utilized for procedures were mounted on an Olympus IX-71 microscope. Research Instruments (RI) air injectors were used for all manipulations. No camera was used for this modified IMSSI procedure. Manipulation was performed in a 10 µl drop of modified human tubal fluid (HTF) with HEPES buffer (InVitroCare, Inc.) supplemented with 10% synthetic serum substitute (SSS; Irvine Scientific) and oil overlay. Spermatozoa were immobilized and evaluated in Sage (Cooper Surgical) medium with 7% polyvinylpyrrolidone (PVP). Injected oocytes were placed in 20 µl drops of embryo continuous culture media (Irvine Scientific) and incubated for 5–6 days at 37°C in a humidified atmosphere of medical mix gas, 6% CO2, 5% O2, balanced N2.
Adjuvants in IVF—evidence for what works and what does not work
Published in Upsala Journal of Medical Sciences, 2020
Luciano Nardo, Spyridon Chouliaras
Large randomised trials in IVF are very hard to pursue as patients are very keen to try novel or already established empirical therapies and therefore being randomised to a placebo arm is unappealing for them. For most of the add-ons presented in this publication, the available evidence is suboptimal, and better-designed studies are essential to give conclusive answers. We will therefore refrain from repeating the same argument separately for each treatment modality. We will also not elaborate on strategies used in order to improve success rates such as: freeze-all, routine use of ICSI for non-male factor infertility, preimplantation genetic testing for all cycles, continuous monitoring of the embryos (time lapse imaging), testing for endometrial receptivity or endometrial microbiome, and advanced sperm selection techniques such as intracytoplasmic morphologically selected sperm injection (IMSI), physiological ICSI (PICSI), and sperm head’s birefringence. It is our belief that these do not strictly speaking constitute adjuvants to treatment, and the decision regarding their use may be influenced by other factors. Instead we will try to focus on what we consider as ‘pure’ add-ons to treatment.