Arie Berkovitz

How to improve IVF–ICSI outcome by sperm selection

In previous studies, a new IVF method of intracytoplasmic morphologically selected sperm injection (IMSI) was introduced, based on motile sperm organellar morphology examination (MSOME). It was concluded that microinjection of morphologically selected sperm cells with strictly normal nucleus, defined by MSOME, improves IVF-ICSI outcome. The aim of the present study was to confirm this conclusion in new, enlarged study groups. Comparison between 80 couples, who underwent an IVF-IMSI trial, with matched couples, who underwent a standard IVF-ICSI procedure, confirmed that pregnancy rate following IVF-IMSI was significantly higher, and abortion rate significantly lower than in the routine IVF-ICSI (60.0 versus 25.0%, and 14 versus 40% respectively, P <or= 0.05). Another comparison was performed between matched IMSI groups, where embryos were obtained from microinjection by spermatozoa with a morphologically normal nucleus (best group, n = 70) and a second best group was selected, where embryos were obtained from microinjection of spermatozoa with minimal morphological impairment, since no other sperm cells were available. It was confirmed that microinjection by second best spermatozoa result in significantly lower pregnancy and delivery rates and significantly higher abortion rates than microinjection with best spermatozoa (25.7 versus 58.2%, P <or= 0.01; 17.1 versus 52.8%, P <or= 0.01, and 33.3 versus 9.7%, P <or= 0.02 respectively). The present study has strengthened previous conclusions.

Selection of spermatozoa with normal nuclei to improve the pregnancy rate with intracytoplasmic sperm injection.

To the Editor: Intracytoplasmic injection of sperm is the recommended treatment for male infertility, associated with an average pregnancy rate per cycle of about 30 percent.1 Although sperm count and motility were found to have no effect on the outcome of intracytoplasmic sperm injection,2 scanning and transmission electron microscopy indicated that the achievement of pregnancy may depend on normal morphology of the sperm nucleus.3 We therefore introduced the motile-sperm organelle-morphology examination (MSOME), by which the fine nuclear morphology of motile spermatozoa is examined in real time with an inverted light microscope equipped with high-power differential interference contrast (Nomarski/DIC) optics (magnification, .xa0.xa0.