Monday, 19 August 2013

IMSI - will superior selection of sperms improve ICSI success outcome?

Intracytoplasmic morphologically-selected sperm injection (IMSI) is an infertility treatment and is believed by some experts to be the most effective treatment to date for male factor infertility. This is simple a modification of the standard ICSI technique, in which the sperm are magnified even further. The rationale is very logically appealing - let's use higher powered magnification, so we can select the best sperm for ICSI. One would therefore expect that this technique would result in higher pregnancy rates after ICSI. The technique involves selecting the best quality sperm cells from a sample provided by the male partner, and injecting them directly into the eggs retrieved from the female partner, thereby increasing the probability that these sperm cells will fertilize the eggs.

Pahlajani Test Tube Baby Centre is proud to be announced that we have new, advanced IMSI equipment in our laboratory and a team of experienced embryologists who carry out the procedure. IMSI is also known as “Super ICSI”, since it is a technique that improves the results of the sperm injection. Fertility treatment just got better with handpicking the best sperm to be fused with the egg. Experts have improvised on intracytoplasmic sperm injection ICSI which is a method in which a sperm is physically injected into an egg but now come up to more advanced feature with the new technique of intracytoplasmic morphologically selected sperm injection (IMSI). The procedure involves use of powerful microscopes to look at and select the healthiest-looking sperm to improve the success rate of conception.

Men with fertility problems do not produce normal, healthy sperms that are capable of swift movement towards the egg. In such cases, ICSI, which stands for intracytoplasmic sperm injection, is the only way to produce an embryo. "But even such procedures fail because sperm we select may not be completely healthy,"

In IMSI, after the microscope magnifies sperm 7,000 times, a computerized semen analysis picks up the best sperm to be fused with the most fertile eggs. Dr Neeraj Pahlajani feels IMSI is superior as it makes the selection process more stringent. After two to five days, the fused egg-sperm is injected into the uterus.

IMSI improves on the successes of ICSI (Intracytoplasmic sperm injection). ICSI, developed in the early 1990s, has itself been found to increase the chances of successful IVF. Male patient who have tried and failed to become fathers through at least two previous IVF attempts were twice likely to succeed through IMSI than through another round of conventional fertility treatment. Unfortunately, this is not true in real life. Not only does IMSI not improve pregnancy rates as compared to ICSI, it can actually decrease them. This is because IMSI takes longer to perform than ICSI. The embryologist has to keep the fragile eggs into which the sperm has to be injected on the micromanipulator for longer while doing IMSI, and since eggs are very sensitive, this extra exposure can cause them to get damaged.

We also know that abnormal embryos are the commonest reason for failed embryo implantation after IVF; and that this is the reason why IVF failure rates increase for older women. Now, since the sperm provide 50% of the genes of the embryo, it is logical to assume that 50% of the time the reason for genetically abnormal embryos and thus failed IVF cycles and recurrent miscarriages would be genetically abnormal sperm.

However, what is logical is not always true.  In reality, studies have shown that there is no correlation between abnormal sperm and failed IVF or miscarriages. Let's look at a very common reason for infertility. This is the problem of abnormal sperm morphology, known medically as teratozoospermia. These are men who have a very large proportion of abnormally shaped sperm - more than 95% abnormal forms. The standard treatment for these men is ICSI, in which a single sperm is injected into an egg to fertilize it.

IMSI versus ICSI versus IVF
In IVF, eggs are harvested from the female partner and left in a dish with sperm cells from the male partner. These sperm cells need to be strong enough having well enough morphological quality to swim to the eggs, penetrate their outer layers and fertilize them. IMSI and ICSI do not rely on the sperm cells' ability to do this - both techniques give the sperm cells a helping hand to reach the inner layer of the egg (the cytoplasm). Where IMSI differs from ICSI, however, is that during IMSI, the embryologist carrying out the procedure uses an extremely high-powered microscope to select the sperm cells with the best morphological quality to be injected into the eggs.

The procedure of IMSI
IMSI begins with standard IVF procedure. The female partner is given ovulation-inducing drugs, and the resulting mature eggs are then harvested from her ovaries and prepared for fertilization in the laboratory. The embryologist will then use the high-powered microscope to examine the male partner's semen sample. He then uses a long, thin, hollow needle to pick up the desired sperm cell. He holds the egg cell in a special pipette, and then uses the needle to push the sperm cell through the outer shell of the egg and into its inner area, where fertilization can take place. The eggs and sperm are then left for 24 hours, during with fertilization is likely to occur. If this is indeed what happens, the now fertilized eggs (embryos) are transferred back to the woman's uterus where hopefully at least one will implant, resulting in a pregnancy.

Risks and drawback

IMSI is significantly more expensive to perform than ICSI, because of the need for specialized training and expensive state-of-the-art equipment. There is also the possibility of a higher risk of multiple pregnancy (twins or triplets) arising from IMSI than from ICSI. But the pregnancy rate among the IMSI couples 35% more success among the couples who used ICSI. Pahlajani Test Tube Baby Centre is eager to provide high quality treatment with high success rates.


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