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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Selection of spermatozoa with normal nuclei to improve the pregnancy rate with intracytoplasmic sperm injection.N Engl J Med. 2001; 345: 1067-1068
- Pregnancy rates are higher with intracytoplasmic morphologically selected sperm injection than with conventional intracytoplasmic injection.Fertil Steril. 2003; 80: 1413-1419
- Real-time fine morphology of motile human sperm cells is associated with IVF-ICSI outcome.J Androl. 2002; 23: 1-8
- Does the presence of nuclear vacuoles in human sperm selected for ICSI affect pregnancy outcome.Hum Reprod. 2006; 21: 1787-1790
- How to improve IVF-ICSI outcome by sperm selection.Reprod Biomed Online. 2006; 12: 634-638
- ART success and in vivo sperm cell selection depend on the ultramorphological status of spermatozoa.Andrologia. 1999; 31: 1-8
- The morphological normalcy of the sperm nucleus and pregnancy rate of intracytoplasmic injection with morphologically selected sperm.Hum Reprod. 2005; 20: 185-190
- High-magnification ICSI overcomes paternal effect resistant to conventional ICSI.Reprod Biomed Online. 2006; 12: 19-25
- Intracytoplasmic morphologically selected sperm injection benefits for patients with oligoasthenozoospermia according to the 2010 World Health Organization reference values.Fertil Steril. 2011; 95: 2711-2714
- Intracytoplasmic sperm injection outcome versus intracytoplasmic morphologically selected sperm injection outcome: a meta-analysis.Reprod Biomed Online. 2010; 21: 450-455
- Correlation between DNA defect and sperm-head morphology.Reprod Biomed Online. 2012; 24: 211-218
- Sperm organelle morphologic abnormalities: contributing factors and effects on intracytoplasmic sperm injection cycles outcomes.Urology. 2011; 78: 786-791
- Significance of large nuclear vacuoles in human spermatozoa: implications for ICSI.Reprod Biomed Online. 2008; 17: 42-45
- Human gene expression first occurs between the four- and eight-cell stages of preimplantation development.Nature. 1988; 332: 459-461
- Sperm DNA fragmentation: paternal effect on early post-implantation embryo development in ART.Hum Reprod. 2006; 21: 2876-2881
- Late, but not early, paternal effect on human embryo development is related to sperm DNA fragmentation.Hum Reprod. 2004; 19: 611-615
- Identifying new human oocyte marker genes: a microarray approach.Reprod Biomed Online. 2007; 14: 175-183
- Expression of genes regulating chromosome segregation, the cell cycle and apoptosis during human preimplantation development.Hum Reprod. 2005; 20: 1339-1348
- Effect of sperm DNA fragmentation on pregnancy outcome depends on oocyte quality.Fertil Steril. 2011; 95: 124-128
- Disruption of maternal DNA repair increases sperm-derived chromosomal aberrations.Proc Natl Acad Sci U S A. 2007; 104: 17725-17729
- WHO laboratory manual for the examination and processing of human semen.5th ed. World Health Organization, Geneva2010
- Improved diagnosis of male fertility potential via a combination of quantitative ultramorphology and routine semen analyses.Hum Reprod. 1994; 9: 2069-2075
- A new real-time morphology classification for human spermatozoa: a link for fertilization and improved embryo quality.Fertil Steril. 2009; 92: 1616-1625
- In vitro culture of human blastocysts.Toward Reproductive Certainty: Fertility and Genetics Beyond. Parthenon Publishing London, London1999
- Assessment of acrosome and nuclear abnormalities in human spermatozoa with large vacuoles.Hum Reprod. 2011; 26: 47-58
- Intracytoplasmic morphologically selected sperm injection: a prospective randomized trial.Reprod Biomed Online. 2008; 16: 835-841
- The IMSI procedure improves poor embryo development in the same infertile couples with poor semen quality: a comparative prospective randomized study.Reprod Biol Endocrinol. 2011; 9: 123
- Intracytoplasmic morphologically selected sperm injection (IMSI) after repeated IVF or ICSI failures: a prospective comparative study.Eur J Obstet Gynecol Reprod Biol. 2013; 167: 76-80
- Intracytoplasmic injection of morphologically selected spermatozoa (IMSI) improves outcome after assisted reproduction by deselecting physiologically poor quality spermatozoa.J Assist Reprod Genet. 2011; 28: 253-262
- Large nuclear vacuoles are indicative of abnormal chromatin packaging in human spermatozoa.Int J Androl. 2012; 35: 46-51
- DNA repair by oocytes.Mol Hum Reprod. 1996; 2: 46-51
- Repair of the ultraviolet-irradiated male genome in fertilized mouse eggs.Science. 1981; 211: 1431-1433
- Female age predicts embryonic implantation after ICSI: a case-controlled study.Hum Reprod. 1996; 11: 1324-1327
- Embryo implantation in in vitro fertilization and intracytoplasmic sperm injection: impact of cleavage status, morphology grade, and number of embryos transferred.Fertil Steril. 1999; 72: 679-685
- The probability of pregnancy after embryo transfer is affected by the age of the patient, cause of infertility, number of embryos transferred and the average morphology score, as revealed by multiple logistic regression analysis.Hum Reprod. 1995; 10: 3035-3041
- Influence of patient age on the growth and transfer of blastocyst-stage embryos.Fertil Steril. 2002; 77: 700-705
- Comparison of blastocyst transfer with or without preimplantation genetic diagnosis for aneuploidy screening in couples with advanced maternal age: a prospective randomized controlled trial.Hum Reprod. 2004; 19: 2849-2858
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.
