in vitro fertilisation (ivf)

IMSI procedure - A solution to male infertility - Advantages, Disadvantages

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IMSI procedure is a male infertility treatment solution with advantages such as improving embryo quality, determining fertility, and reducing the chances of miscarriage. IMSI procedure is combined with IVF when infertility specialist finds out that it is required to suffice the treatment results.

Let’s Discuss in More Detail About IMSI As A Solution To Male Infertility:

The intracytoplasmic morphologically selected sperm injection (IMSI) is a laboratory technique used for IVF (In Vitro Fertilization treatments). Under this process, high-quality sperms are injected into the egg for fertilization. IMSI was introduced in 2001, and it is an advanced version of ICSI. With the help of a high powered microscope, the best sperm cells are picked out which are used in a traditional ICSI protocol. This method is useful if sperms need to be examined in greater detail, including the nucleus which contains the genetic material of a sperm. IMSI has resulted in lower abortion rates and higher pregnancy and delivery rates. IMSI can be a good option for anyone who has failed IVF cycles in the past or for couples who have male infertility issues. With the IMSI technique, scientists are able to assess the structure of the sperms and exclude the sperms with suspected abnormalities from being injected into the available eggs.

ivf procedure, ivf treatment

Cases Where IMSI can be Used

Achieving a healthy pregnancy is hugely dependent on the quality of the human embryo. The quality of an embryo is a product of the quality of both the egg and the sperm. If sperms have abnormalities, they can still create embryos but these are unlikely to implant or may result in an early miscarriage. Some sperm abnormalities can be identified using a microscope which magnifies up to 400 times. With IMSI the magnification is up to 6000 times, which enables the embryologists to see abnormalities in the head of the sperm with more accuracy. By selecting sperms without abnormalities, the chances of creating better quality embryos are higher.

IMSI can be used under the following conditions:

  • When there is high levels of DNA fragmentation in the sperm sample
  • If the sperms are susceptible to oxidation damage or poor sperm morphology
  • Repeated abortions or a history of miscarriage
  • When there is more than 90 percent of sperm abnormality
  • If few embryos make it to the blastocyst stage
  • Repeated pregnancy failures despite the transfer of several quality embryos
  • Age of male partners over 40 years
  • Two failed ICSI Cycles (Failed cycles constitutes no pregnancy or first-trimester miscarriage)
  • Three failed IVF cycles
  • Increased levels of sperm aneuploidy
  • If the quality of the egg has seemed to be normal but still there is no implantation
  • Deficiency in the levels of sperms or a high percentage of irregular formed cells.

Process of IMSI

IMSI and ICSI require high resolution and high contrast microscopes that are equipped with micromanipulation. The process of IMSI is usually carried out in a petri dish sitting on a heated microscope stage glass insert. Once the best sperm is selected the IMSI procedure is carried out in exactly the same way as ICSI.

The process of IMSI includes the following step:

  • Firstly eggs are harvested and incubated.
  • Morphological selection of a healthy egg is done with an inverted microscope
  • The oocyte is maintained by a holding pipette and the semen is analyzed with an upright microscope
  • The healthy sperm cell is selected by using an inverted microscope with high magnifications
  • A glass micropipette is used to paralyze the selected sperm by cutting its tail
  • The sperm is directed to the inner part of the oocyte by piercing the oocyte through the membrane.
  • The sperm is then released into the oocyte

It is important that the cellular structures like the polar body of the egg cell and zona pellucida must be clearly detectable. The shape and vacuole count of the sperm cells must also be assessed.

process of IMSI

Advantages of IMSI

  • IMSI method doubles pregnancy rates and lower abortion rate by 60 percent during the first trimester
  • The chance of miscarriage can be reduced by selecting better sperm
  • IMSI facilitates the interaction between spermatozoa and oocyte
  • It bypasses seminal abnormalities like reduced number, motility or increased morphological defects of spermatozoa. 
  • Sperm morphology plays an important role in determining fertility. It is proven to be closely related to fertilization and pregnancy rates in the natural fertilization process
  • Normal sperm morphology is necessary for the successful passage through the zona pellucida and fusion with the plasma membrane of the oocyte
  • IMSI has been related to improving the embryo quality, with a higher percentage of embryos to reach the blastocyst stage

According to a study it has been found that the success rate of IMSI is 66 percent as against 33 percent in case of a normal sperm Injection. Today, the IMSI procedure has many benefits for men with teratozoospermia, especially in severe cases where most sperms are abnormally shaped.

Disadvantages

IMSI is preferred only when sperm quality is too low or in cases of repeated IVF or IVF with ICSI failure. IMSI has also some disadvantages, which include:

  • IMSI is time-consuming; it adds a considerable amount of extra time to the IVF procedure of about 1.5 to 5 hours.
  • IMSI is expensive, due to its elevated cost; it is not available in most IVF laboratories and clinics.
  • IMSI is more likely to lead to multiple pregnancies in comparison to the ICSI technique.

IMSI Treatment with IVF

IMSI can improve significantly the chances of fertilization with IVF and can be used if an IVF cycle has been unsuccessful earlier. The IMSI treatment refers to the procedure of the IVF treatment that is done to examine and select sperm using an inverted microscope that is able to provide more clarity (around 6000 times) than that of normally used microscopes in reproductive laboratories (400 times) to carry out ICSI. An effective selection of sperms without morphological alterations is likely to increase the chances of successful implantation of the pre-embryo and decrease the likelihood of a miscarriage.

About10 percent of couples are estimated to seek assistance for infertility problems during their reproductive years. Infertility is associated either with male or female infertility problems. The cause of infertility remains unexplained in certain cases or is related to a combination of male and female factors. Assisted reproductive technologies are often considered as the first-line treatment to achieve pregnancy in infertile couples because the underlying conditions can be identified and treated only in a few cases. IMSI is used when the quality of sperms is too poor for conventional IVF to work. IMSI allows almost any man with sperm, either in his semen or in his testis, to try IVF.

The method of using IMSI still requires more study to demonstrate its efficacy and validity in order to be used routinely in the assisted reproduction laboratory and to be recommended with sufficient scientific evidence.

You can also find more information on elawoman.com. Consult Elawoman for fertility issues. Ela can also recommend various infertility treatment plans to suit your needs. To know more about IMSI with IVF treatment cost and other issues you can call us at +917899912611.

Dr. R K Sharma

About The Author

Reproductive Endocrinologist, Hysteroscopic Surgeon Dr. R K Sharma
Delhi

Dr. R K Sharma has completed MBBS and MD in Obstetrics and Gynecology from Pune University in 1981 and 1989 respectively. Dr. R K Sharma is one of the pioneers in the field of IVF treatment in India. He specializes in IUI, IVF, Embryo transfer and Hysteroscopy procedures. He is also a member of Federation of Obstetrics and Gynecology Societies of India (FOGSI). Dr. R K Sharma is presently practicing at Primus Super Specialty Hospital, Chanakyapuri, Delhi. To know more, visit elawoman.com

5 Comments

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Sudheer Gupta

I never knew about IMSI treatment. Thanks, Ela for sharing this and enlightening us.

Oct. 10, 2018, 2:21 p.m. 5.0

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Geetika Chawla

I had a fever for 3 days along with abdominal cramps as a side-effect of IMSI treatment. But it got successful and I am pregnant now.

Oct. 3, 2018, 5:56 p.m. 4.5

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Sakshi Rudra

Our IMSI treatment was successful after three failed IVF. Many thanks to the doctors.

Dec. 14, 2017, 4:03 p.m. 5.0

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Deepti Chopra

There are women who have conceived with a much longer cycles. You need to follow a proper diet plan and do some kind of exercises. Do have lots of veggies and fresh fruit juices in the diet plan. It will help.

Nov. 3, 2017, 12:41 p.m. 5.0

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Nazira

My cycles are 44 days long. Can I get pregnant?

Aug. 30, 2017, 9:43 a.m. 4.5

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