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IMSI Treatment with IVF, ICSI

The intracytoplasmic morphologically selected sperm injection (IMSI) is no doubt a laboratory technique made use of for In Vitro Fertilization treatments and does involve inserting morphologically selected sperm into the egg. A prior sperm sorting is indeed conducted and those with abnormalities that could prevent pregnancy are discarded.

The Intra Cytoplasmic Sperm Injection selected, better known as IMSI for its acronym in English (Intracytoplasmic morphologically-selected sperm injection) is a laboratory technique used in IVF treatments (IVF) and does involve inserting sperm into one’s egg.

IMSI is indeed a real-time method whereby sperm is selected before the microinjection takes place. This is done making use of an inverted microscope that does provide much greater magnifying power (around 6000 times) than that which is normally used in reproductive laboratories (400 times) in order to carry out ICSI.

With this microscope, biologists are able to see the internal morphology of the sperm and also discard those with abnormalities. Being able to select the sperm without morphological alterations are indeed believed to increase the chances of successful implantation of the pre-embryo and also decreases the likelihood of miscarriage.

This technique will require more study to demonstrate its efficacy as well as validity in order to be used routinely in the assisted reproduction laboratory and to be recommended with sufficient scientific evidence.

IMSI may also improve the chances of fertilization in vitro and can also be made use of if one has to perform several unsuccessful In Vitro Fertilization attempts.

Intracytoplasmic Sperm Injection (ICSI)

ICSI treatment has indeed been able to allow couples whereby there is a significant male factor problem in order to achieve treatment success quite similar to those with other causes of sub-fertility. Prior to its introduction in 1992, these couples would indeed have not achieved fertilization or very low fertilization rates thus making use of standard IVF techniques.

Couples do prepare for ICSI in the same way as for standard IVF, which involves ovarian stimulation as well as egg collection. A single motile morphologically normal sperm is rather carefully identified and then picked up making use of a tiny pipette and carefully injected directly into the cytoplasm (center) of each respective mature egg. The fertilized embryos are rather allowed to develop as for the standard IVF prior to the transfer.

With ICSI, very few sperms are indeed required and this process does involve the direct penetration of the sperm into the egg. It is usually recommended:

• When the sperm count is very low
• When the sperm cannot actually move properly or are rather in

other ways abnormal

• When the respective sperm has been surgically retrieved rather directly from either the epididymis (the coiled tubing situated outside the testicles which store the sperm) or testicle itself
• When there are of course high levels of antibodies in the semen that can affect indeed fertilization
• When there have been indeed previous low fertilization or even fertilization failures
• When there is a rather high level of sperm DNA damage

What else is there to know?

As ICSI bypasses the rather potential benefit of natural selection that is observed in IVF where thousands of sperm are indeed left to attempt the fertilized egg in the right conditions, we do not actually believe that ICSI should be the treatment of choice unless one of the above criteria are actually met.

Rarely one must take note of the fact that there are no mature eggs that are available for injection and a small percentage of eggs (<10%) may get damaged by the injection process and will actually be no longer be viable. However, in both of these respective scenarios, intrinsic egg quality is rather likely to be the main problem rather than the ICSI process itself. Whilst ICSI maximized the chances of successful fertilization in those with severe male factor fertility, there is still a 1-3% risk of couples who fail to achieve any fertilized eggs.

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