There’s a method of selecting sperm under really high magnification – something like six thousand, seven thousand times magnified and allows the practitioner to view the sperm head and tail and midpiece – the morphology of sperm in more detail before they select them, before they inject it into the eggs. This is a procedure to select better quality sperm in cases where there’s fewer sperm available for ICSI or there’s overalls and poor sperm quality in the sample. However, it’s noted as a red and the HFEA traffic light system because there’s little evidence to suggest that it does improve sperm or pregnancy outcomes and live birth rates. So, therefore it’s a technique that’s used in some clinics and it does within those clinics improve outcomes but overall there’s limited evidence to suggest that it has an advantage over conventional ICSI.
IMSI is the method where we use our technology and our new technology in the lab to magnify the spermatozoa and through magnification, to identify the ones that have a better morphology compared to the others. With a conventional microscope, small vacuoles or small morphological abnormalities cannot be identified. So with the IMSI for the first time, we have the ability to identify and exclude spermatozoa of lower microscopic morphology. With this approach, we tend to optimize sperm selection in an effort to improve overall prognosis and overall chances for higher fertilization, higher blastulation rate and higher pregnancy rates. However, in one of the latest Cochrane studies, the benefit of using IMSI for sperm selection was marginal. So more data and more studies are required before we establish the benefit of the use of IMSI for our patients.
IMCI is the same technique as ICSI; it’s exactly the same but in this case, we have a big objective and we select the sperm. We can see whether the head and midpiece is good and if we have bags inside the head of sperm, for example. So we select the best morphology with this technique.
Some magnifying lenses are used to magnify the sperm at the time of selection for ICSI. On the face of it it sounds like a good idea – you’re getting a closer look, then you can get the nice looking or the nicer looking spell and inject it. Most patients don’t benefit from it and when you look again at the research and the evidence, there is nothing to suggest that it’s superior to the standard magnifications like 40 times that people use, like 60 times with standard ICSI and knowing that, some clinics would charge a few hundred pounds extra. I would also be reluctant to make that investment because it is less likely to be worthwhile.
IMSI – Intracytoplasmic morphologically selected sperm injection is a sperm selection method used in ICSI and includes the use of a microscope which offers very high magnification, so that the embryologist can have very detailed images of the sperm. It has been suggested that IMSI could be beneficial for specific groups of patients such as couples with previously failed ICSI attempts. However, HFEA has given a red symbol for IMSI – meaning that there is no high quality research that supports the use of IMSI over standard ICSI. Concerning its safety, IMSI as is not an invasive procedure, it does not carry any additional known risks for the patient or the child born.
IMSI is essentially ICSI but on a much higher magnification. What we can see is when we are doing a sperm selection process, we use that higher magnification to deselect sperm that we would have otherwise selected, so we can see any sort of defect within that sperm. We can select those absolutely textbook perfect sperm, if there are any, and it won’t necessarily increase your fertilization rate or your embryo development in the first few days, but there is limited evidence suggesting that you improve your blastocyst formation rate because from day three to day five, that’s when their sperm component comes into your embryo development switches on the embryonic genome which allows blastocyst formation and and if you select the best sperm, the theory might be that you can improve that blastocysts formation rate. Again, the evidence isn’t the greatest and again it’s red lighted by the HFEA, the UK regulator. Like it’s just the case by case patient specific if they’ve had poor blastocyst development before, it’s something that we can offer but not across every patient, there’s no need.
IMCI is very very similar to ICSI when we select and we inject a single sperm inside the oocyte under a special microscope. The difference between ICSI and IMSI is that IMSI is using a higher magnification to view the sperm. It’s around 6000 times more so we can see better if there are any abnormalities on the sperm. Again research has shown that the IMSI doesn’t improve pregnancy rates; some clinics do prefer to offer IMSI, others they just stick with the standard ICSI.
IMSI or Intracytoplasmic Morphologically-selected Sperm Injection, also known as Super-ICSI is a sperm selection technique based on spermatozoa morphology. To do IMSI, we use specific microscopes that help us magnify the head of spermatozoa up to 16,000 times, instead of standard microscopes that magnify only up to 400 times. This way, we select the best spermatozoa, one by one, to perform ICSI and inseminate oocytes, also, one by one.
This technique is recommended for patients with an abnormal semen analysis where only 1-3 % of spermatozoa are normal from a morphological point of view. It’s also recommended for patients with long-term sterility and repeated IVF failures. In this specific group of patients, IMSI has shown to give higher pregnancy rates and lower miscarriage rates.
IMSI is a technique that is very similar to ICSI. ICSI is the acronym for intracytoplasmic injection of the sperm. That means what the biologists do in the lab, in the sperm sample, they look for the sperm that looks and moves the best and, then, they select those sperm to inject inside the eggs to try to fertilize them. When we use IMSI, what the biologists do, they use another kind of microscope with bigger potency and, then, they also select the sperm according to its morphology. Some small studies are saying that maybe in patients who have low morphology, or patients who have teratozoospermia in the sample, IMSI might help to have better results and to diminish the risk of miscarriage or the risk of having embryos that do not implant.
Nevertheless, those studies are very scarce, not conclusive, there is no evidence to support that. In our experience, we have seen very similar results with ICSI or IMSI, so this is why we do IMSI in our clinic.
One of the techniques that we use, especially when we find alterations in the DNA of the sperm, when we find that the DNA fragmentation is high, we use a device called Fertile. It helps to select better sperm that is less fragmented, and we have seen very good results with that technique: it reduces the risk of embryos that are chromosomally abnormal and, also, the risk of miscarriages.
