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Volume 15, Issue 5 (September 2013) 15, 608–615; 10.1038/aja.2013.54

Focus on intracytoplasmic morphologically selected sperm injection (IMSI): a mini-review

Giuseppe Lo Monte1, Fabien Murisier2, Isabella Piva1, Marc Germond2 and Roberto Marci1

1 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara 44121, Italy
2 CPMA, Centre of Reproductive Medicine, 1003 Lausanne, Switzerland

Correspondence: Dr R Marci, (roberto.marci@unife.it)

Received 11 October 2012; Revised 11 January 2013; Accepted 8 April 2013 Advance online publication 8 July 2013


Intracytoplasmic sperm injection (ICSI) is the recommended treatment in many cases of male-factor infertility. Several studies have demonstrated a positive correlation between optimal sperm morphology and positive ICSI outcomes. In fact, spermatozoa with severe abnormalities of the head are well documented to be associated with low fertilisation, implantation and pregnancy rates. However, a spermatozoon which is classified as ‘normal’ by microscopic observation at low magnification could contain ultrastructural defects that impair both the fertilisation process and embryonic development. The intracytoplasmic morphologically selected sperm injection (IMSI) procedure changed the perception of how a spermatozoon suitable for injection should appear. Sperm selection is carried out at ×6000 magnification, allowing improved assessment of the sperm nucleus. Currently, standardized clinical indications for IMSI are lacking and the candidates are selected on the grounds of their medical history or of a careful analysis of the sperm suspension. Further prospective randomized studies are needed to confirm the advantages of IMSI in specific groups of patients. In addition to providing a brief overview of the IMSI procedure, this study aims to review the literature, which explains the theoretical basis and the clinical outcomes of this technique. Several reports show that IMSI is associated with improved implantation and clinical pregnancy rates as well as lower abortion rates when compared to ICSI. Although a possible correlation between the sperm's abnormal nucleus shape, increased DNA fragmentation and negative laboratory and clinical outcomes has been long investigated, the results are conflicting.

Keywords: assisted reproduction technologies; ICSI; IMSI; infertility

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