Abstract
Objective
To evaluate advanced maternal age as a rationale for performing intracytoplasmic morphologically
selected sperm injection (IMSI).
Study design
This study included couples undergoing intracytoplasmic sperm injection (ICSI) as
a result of advanced maternal age (≥37 years old). Sample size calculations were based
on the assumption that a 15% difference in implantation rate would mean a clinically
significant difference. To achieve this difference, 33 cycles would be needed in each
treatment arm (with a significance level of 5% and power of 85%). Couples were randomly
allocated to one of two sperm selection procedures (ICSI, n = 33; or IMSI, n = 33). Sperm selection in the ICSI group was analyzed under a magnification of 400×.
Sperm selection in the IMSI group was analyzed under high magnification of 6600×.
The groups were compared with regard to the outcome of the cycles.
Results
IMSI cycles showed significantly higher implantation (4/33, 12.1% vs. 18/47, 38.3%,
p = 0.026) and pregnancy (4/29, 13.8 vs. 18/30, 60.0%, p < 0.001) rates. The IMSI procedure positively influenced the blastocyst formation rate
(RC: 15.00, R2: 49.9%, p = 0.001) and implantation rate (RC: 24.04, R2: 9.6, p = 0.027), and was determinant to the increased odds of pregnancy (OR: 9.0, CI: 2.17–37.38,
p = 0.001).
Conclusion
It seems that the injection of a morphologically normal spermatozoon overcomes the
low oocyte quality in older women, resulting in improved embryo quality and in a 9-fold
increase in the clinical pregnancy rate in couples with advanced maternal age.
Keywords
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Article info
Publication history
Published online: September 20, 2013
Accepted:
September 3,
2013
Received in revised form:
July 22,
2013
Received:
April 16,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.