Intracytoplasmic Morphologically Selected Sperm Injection

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What is IMSI?

Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) is an advanced assisted reproductive technology, a boon for severe male factor infertility. IMSI is an advanced version of ICSI having a magnification power of 16 times higher compared to ICSI.

IMSI treatment offers various advantages like improved embryo quality and selection of viable sperms. It also helps to reduce the chances of abortion.

In ICSI, before sperm microinjection, we observe the sperms under the microscope of 500 times magnification. But in IMSI, the sperm is being examined under high power of 6600 times before microinjection. IMSI allows the embryologist to see the spermatozoa’s detailed structure, thereby detecting potential abnormalities in the head, middle-piece, and tail of the sperm. This technique thus enables our embryologists to select healthier sperms.

Steps involved in the IMSI procedure are:

Semen sample preparation

Step 1: Semen sample preparation

After collecting the semen sample, it is first treated with a specific solution to remove any impurities.
An embryologist separates the viable cells utilizing centrifugation on the day of the IMSI procedure.
Sperm selection

Step 2: Sperm selection

An embryologist examines the sperms under a microscope for choosing a suitable sperm for injecting in the egg.
IMSI helps to determine the sperm morphology through a high magnification of around 6600X. The embryologist only chooses morphologically normal sperm for injecting in the egg.
Such sperms provide a better pregnancy rate. We can also observe even the minute and multiple vacuoles. Sperms with large vacuoles and abnormal head size are not selected. This way, it helps choose the most viable sperms.
Egg selection

Step 3: Egg selection

A needle is transvaginally introduced under ultrasound-guidance to aspirate the egg follicles for collecting the eggs. After the egg collection, the eggs are first washed with an enzyme to remove unwanted components. It is then observed under an inverted microscope for choosing healthy eggs.
Sperm injection

Step 4: Sperm injection

The selected sperm is then placed in a pipette and then injected into the egg under the microscope. The microinjected eggs are being cultured in a sterile culture petri dish in an incubator overnight.
Further, to observe the signs of fertilization, the microinjected eggs are checked at regular intervals. After the embryo formation, the embryos are inserted into the uterus.
After two weeks, a urinary pregnancy test is done for confirmation of pregnancy to plan further steps.

Why perform an IMSI?

IMSI treatment in India increases the possibility of embryo fertilization and development, especially in males with failed IVF or ICSI treatment or with a high number of abnormal sperms. The significant feature of IMSI is that it selects the sperm with great precision. It involves the examination of sperms at thousand times increased magnification. Thus, minor morphological sperm abnormalities can be detected, which are usually missed with ICSI. In ICSI, the sperms may look healthy, but they may not have fertilization potential.

Why perform an IMSI

We can have a better-selected sperm and better fertilization rate in males with severe oligospermia or asthenozoospermia or teratozoospermia with IMSI. IMSI is better than ICSI for selecting the embryos and thus ensures a better success rate.

In our patients, we have seen that IMSI has improved clinical pregnancy rates. It has also reduced abortion rates in many cases. The viable sperms selected using IMSI can further be used for IVF or ICSI treatment to increase the probability of the treatment’s success.

Who is suitable for an IMSI treatment?

Mostly, experts recommend the IMSI treatment in India for men with:

  • A high quantity of irregularly shaped sperms
  • A low amount of normal sperm in a semen sample
  • Low sperm motility
  • Previous failed ICSI or IVF treatment
  • Age more than 40 years

IMSI treatment can be a great choice in conditions like,

  • High level of DNA fragmentation in the semen sample
  • Multiple previous abortions or miscarriage
  • Two or more unsuccessful ICSI or IVF cycles

What is the advantage of IMSI?

  • In IMSI, the risk of miscarriage is reduced as the chance of genetic abnormality in the embryo is less with a morphologically normal sperm selection.
  • IMSI treatment increases pregnancy rates due to improved embryo quality.
  • The chances of conceiving are high in IMSI as the intracellular damage is easily detected.
  • It is also beneficial in couples having unexplained infertility.

What is the disadvantage of IMSI?

  • Despite many advantages, IMSI also possess some disadvantages, including,
    • IMSI is a time-consuming process; it requires an extra time of about one to two hours compared to the IVF procedure.
    • IMSI is costlier than ICSI; hence, it is not available in most IVF labs.

    Due to all these reasons, the specialists suggest IMSI only when low or poor sperm quality or repeated ICSI or IVF failure.

What is the success rate of IMSI?

The success rate of IMSI in comparison with ICSI

Live births 20%-30% 25%
Risk of miscarriage 5%-10% 7%
Clinical pregnancy 35%-44% 32%

Through IMSI, we discovered that couples had higher pregnancy and live birth rates and reduced miscarriage rates. MSI also improves the success rate of IVF as it increases embryo implantation rate. Compared to ICSI, IMSI also reduces the aneuploidy rate.

IMSI helps improve the success rate in males with poor prognosis. It is more helpful than ICSI in patients with previous IVF or ICSI failures. IMSI has resulted in improved egg fertilization rates, good quality embryos, improved blastocyst formation rate, and higher pregnancy rates.

Seek an appointment with Dr. Rainee Agrawal with the excellent male infertility services.

Prenatal sex determination & sex selection is illegal in India and not done here. It is a punishable offence.

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