Intracytoplasmic morphologically selected sperm injection (IMSI): a critical and evidence-based review

Basic and Clinical Andrology

Anick De Vos¹  Nikolaos P Polyzos¹  Greta Verheyen¹  Herman Tournaye¹ 

[1] Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium

关键词: Acrosome reaction;    Sperm aneuploidy;    Sperm chromatin;    DNA fragmentation;    Sperm nuclear vacuoles;    Sperm nuclear morphology;    Sperm morphology;    MSOME;    High-magnification microscopy;    IMSI;   

Others  :  795128
DOI  :  10.1186/2051-4190-23-10

 received in 2013-06-13, accepted in 2013-09-02,  发布年份 2013

【 摘 要 】

Introduced in 2001, intracytoplasmic morphologically selected sperm injection (IMSI) represents a more sophisticated way of ICSI whereby, prior to injection, the spermatozoon is selected at higher magnification. Doing so, the spermatozoon can be evaluated for fine integrity of its nucleus and the injection of a normal spermatozoon with a vacuole-free head can be assured.

Additional research is needed to unravel the underlying mechanisms responsible for the presence of vacuoles in sperm heads. Associations with acrosome status, chromatin condensation, DNA fragmentation and sperm aneuploidy have been documented, however, controversy on their nature exists. Spermatozoon shape and large vacuoles are detected and deselected in conventional ICSI as well. However, the detection of subtle small vacuoles depends on the resolving power of the optical system and may impact oocyte fertilization, embryo development and implantation.

Several comparative studies have indicated that the use of high-magnification sperm selection was associated with both higher pregnancy and delivery rates, whereas also lower miscarriage rates were observed. However, still to date randomized, well-powered studies to confirm these findings are scarce and show conflicting results. Hence, the most relevant indications for IMSI still remain to be determined. Two groups of patients have been put forward i.e. severe male-factor infertility patients and patients with a history of repeated ICSI failures. However, for both groups limited to no proof of any benefit does exist.

IMSI is a time-consuming procedure at the expense of oocyte ageing. The lack of proof and understanding of its benefit does not justify its routine clinical application at present.

【 授权许可】

   
2013 De Vos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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