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Research Article| Volume 171, ISSUE 2, P286-290, December 2013

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Intracytoplasmic morphologically selected sperm injection is beneficial in cases of advanced maternal age: a prospective randomized study

  • A.S. Setti
    Affiliations
    Instituto Sapientiae – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, 04503-040 São Paulo, SP, Brazil

    Fertility – Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, 01401-002 São Paulo, SP, Brazil
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  • R.C.S. Figueira
    Affiliations
    Fertility – Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, 01401-002 São Paulo, SP, Brazil
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  • D.P.A.F. Braga
    Affiliations
    Instituto Sapientiae – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, 04503-040 São Paulo, SP, Brazil

    Fertility – Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, 01401-002 São Paulo, SP, Brazil
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  • T. Aoki
    Affiliations
    Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Junior, 61, 01401-002 São Paulo, SP, Brazil
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  • A. Iaconelli Jr.
    Affiliations
    Instituto Sapientiae – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, 04503-040 São Paulo, SP, Brazil

    Fertility – Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, 01401-002 São Paulo, SP, Brazil
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  • E. Borges Jr.
    Correspondence
    Corresponding author at: Av. Brigadeiro Luis Antonio, 4545, 01401-002 Sao Paulo, SP, Brazil. Tel.: +55 11 3018 8181; fax: +55 11 30188182.
    Affiliations
    Instituto Sapientiae – Centro de Estudos e Pesquisa em Reprodução Humana Assistida, Rua Vieira Maciel, 62, 04503-040 São Paulo, SP, Brazil

    Fertility – Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, 01401-002 São Paulo, SP, Brazil
    Search for articles by this author
Published:September 20, 2013DOI:https://doi.org/10.1016/j.ejogrb.2013.09.006

      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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