By BSc (embryologist), MD, FACOG, FACS, FACE (reproductive endocrinologist) and BSc, MSc (embryologist).
Last Update: 07/20/2018

Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) is an improved type of ICSI (Intracytoplasmic Sperm Injection), and both techniques are used in IVF cycles to increase the success rates.

Today, the IMSI procedure is used to improve the sperm selection process before it is injected into the egg cell.

This state-of-the-art technique has many benefits for men with teratoozospermia, especially in severe cases where most sperms are abnormally shaped.

IMSI vs. ICSI

The many improvements made in the field of Assisted Reproductive Technology (ART) have allowed improved and innovative techniques to be available for IVF patients, all of them developed to increase the success rates of fertility treatments.

IMSI, also known as Super-ICSI, is one of these cutting-edge technologies, which uses a special lens for the microscope, which enables an increase greater than 6300-fold of spermatozoa. This is a major advantage in comparison with ICSI, in which sperm are selected individually under a microscope at 400x magnification instead of 6000x.

In short, IMSI allows the embryologist to see the structure of spermatozoa in detail, thereby detecting potential abnormalities and defects in the head, middle-piece, and/or tail.

According to the World Health Organization (WHO), for a sperm cell to have an excellent morphology, it must have the following characteristics:

  • Oval head
  • Straight or uncoiled tail
  • Fixed nucleus
  • Transparent color

Moreover, the acrosome must be intact and not contain vacuoles.

Currently, the most widely used technique used in IVF cycles is ICSI, especially in cases of severe male infertility, or when the sperm count, motility, or morphology are affected.

However, ICSI is a subjective technique, as it is the specialist who chooses the sperms following his personal criteria when observing the head, middle-piece, and tail.

Thanks to IMSI and the improvements that it adds to the process of examining and selecting sperms, the pregnancy success rates can improve in cases of male infertility.

When we select the sperms with the best morphology only, we dismiss those with poor morphology, which doesn’t mean that they were unable to fertilize the egg. Poor morphology increases the risk of implantation failure and miscarriage, though.

When is it used?

Severe male infertility is one of the most common causes of male infertility. For example, a man has low sperm quality when the sperm count is poor, the sperms are too slow, or the sperm morphology is abnormal.

As for IMSI in particular, it is indicated when sperm morphology is altered, a disorder that is known as teratozoospermia or teratospermia.

Selecting sperms with a good or normal morphology increases the pregnancy success rates in patients with infertility.

Moreover, IMSI can be used in the following cases as well:

It should be noted that IMSI is not used on a regular basis in IVF labs. It is used in very special cases only, as the cost is considerably high and it does not increase the success rates in all cases.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Benefits of IMSI

The main benefit of IMSI is that it allows for an accurate visualization of sperm cells, that is, an increase greater than 6300-fold of spermatozoa. To sum up, IMSI is 15 times more powerful than conventional microscopes used in IVF/ICSI cycles.

With IMSI, live sperms can be selected in real time. Thanks to it, dye tests that could damage the sperm cells become unnecessary to check sperm quality.

Visualizing the sperms in such detail not only allows us to detect potential head defect, but also in the middle-piece or neck, an the tail. The presence of such defects is associated with sperm DNA fragmentation.

The IMSI technique increases the fertilization and pregnancy rates, whilst decreasing the miscarriage rate.

Disadvantages

In spite of all the advantages that IMSI can add to your fertility treatment, it also has some cons that one should consider, including:

  • It adds a considerable amount of extra time to the IVF procedure: about 1.5 to 5 hours.
  • Due to its elevated cost, it is not available in most IVF laboratories.

For all these reasons, IMSI is used only when sperm quality is too low or in cases of repeated IVF or IVF with ICSI failure.

More research is necessary as regards this technique in order to prove its clinical efficacy and determine the cases when it is actually required more accurately.

FAQs from users

What are the advantages of IMSI?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

Selection of individual sperm under high magnification microscope, (intracytoplasmic morphologically selected sperm injection or IMSI), involves the uses the apparent most optimal sperm by shape (morphology) in men with the most severe male factor. IMSI has been a consideration in patients with recurrent implantation failure or spontaneous miscarriages (Lo Monte et al. 2013) due to the opinion the pregnancy failures were due to a sperm defect. However, recent studies have opposed this view by showing IMSI does not improve outcomes for men undergoing multiple IVF cycles. (Oliveira et al. 2011, Gatimel et al. 2016).

Is IMSI possible with sluggish sperm?

By Zaira Salvador BSc, MSc (embryologist).

Yes, IMSI is possible with sperm samples that contain sluggish sperm, that is, samples with asthenozoospermia, as long as it is indicated for the reasons explained above.

The main purpose of IMSI is to select the sperm cells with the best morphology only. To select sperms with progressive motility, however, conventional ICSI is the technique of choice.

How does IMSI work?

By Zaira Salvador BSc, MSc (embryologist).

The IMSI procedure is the same as in ICSI cycles. First, the sperm sample is processed in the lab, and the pellet is resuspended at the adequate concentration. The only difference between IMSI and ICSI is the microscope used to select the sperms morphologically with IMSI. This type of microscope is based on the MSOME technology (Motile Sperm Organelle Morphology Examination), which is equipped with a digital imager.

Once the embryologist selects the best sperms, they are transferred to the ICSI plate and taken to a conventional microinjector to fertilize the eggs.

Why does IMSI take too many steps?

By Zaira Salvador BSc, MSc (embryologist).

Because it is a very laborious technique that can be conducted by highly trained professionals only. Oftentimes, it requires two embryologists to work simultaneously in order to reduce the duration of the process and perform it more objectively.

Moreover, due to the use of a more powerful microscope, finding sperm cells under the microscope becomes a tedious task, which turns it into a technically challenging technique.

Suggested for you

We have mentioned teratozoospermia as the main indication for IMSI to be used. To get a much deeper insight on this sperm disorder, we recommend that you visit the following post: What Is Teratozoospermia? – Causes, Pregnancy Rate & Treatment.

According to the WHO, a semen analysis is the most useful tool when it comes to evaluate male fertility, as it is used to detect potential sperm disorders. Learn more about it here: What Is a Semen Analysis Report? – Purpose, Preparation & Cost.

Today, ICSI is the most widely used technique in IVF labs. Get more info by clicking the following link: What Is ICSI Technique? – Process, Success Rates & Cost.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Bartoov B, Berkovitz A, Eltes F, Kogosovsky A, YagodaA, Lederman H, et al. Pregnancy rates are higher with intracytoplasmic morphologically selected sperm injection than with conventional intracytoplasmic injection. Fertility and Sterility 2003;80(6):1413–9. [PUBMED: 14667877]

Berkovitz A, Eltes F, Yaari S, Katz N, Barr I, Fishman A, et al. The morphological normalcy of the sperm nucleus and pregnancy rate of intracytoplasmic injection with morphologically selected sperm.Human Reproduction2005;20(1):185–90. [PUBMED: 15471930]

Berkovitz A, Eltes F, Lederman H, Peer S, Ellenbogen A,Feldberg B, et al. How to improve IVF-ICSI outcome by sperm selection.Reproductive Biomedicine Online2006;12(5):634–8. [PUBMED: 16790113]

Cassuto NG, Hazout A, Benifla JL, Balet R, Larue L, Viot G. Decreasing birth defect in children by using high magnification selected spermatozoon injection. Fertility and Sterility 2011;1:S85.

Oliveira JBA, Cavagna M, Petersen CG, Mauri AL, Massaro FC, Silva LFI, et al. Pregnancy outcomes in women with repeated implantation failures after intracytoplasmic morphologically selected sperm injection(IMSI).Reproductive Biology and Endocrinology2011;9:99.[PUBMED: 21781299]

Teixeira DM, Barbosa MAP, Ferriani RA, Navarro PA, Raine-Fenning N, Nastri CO, Martins WP.Regular (ICSI) versus ultra-high magnification (IMSI) sperm selection for assisted reproduction.Cochrane Database of Systematic Reviews2013, Issue 7. Art. No.: CD010167.

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Authors and contributors

 José Antonio Sánchez Férez
José Antonio Sánchez Férez
BSc
Embryologist
Bachelor's Degree in Biology from the University of Murcia. Vast experience as an embryologist, biologist, and researcher. Currently, he works as a Clinical Embryologist at Instituto Murciano de Fertilidad (IMFER). More information about José Antonio Sánchez Férez
 Mark P. Trolice
Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information about Mark P. Trolice
License: ME 78893
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV

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