What You Should Know About Intracytoplasmic Morphologically Selected Sperm Injection (IMSI)

What is IMSI?

Intracytoplasmic morphologically selected sperm injection (IMSI) is an IVF technique using a high-magnification digital imaging microscope to examine and select sperm for microinjection into the egg.

IMSI allows scientists to better assess sperm structure and exclude those with suspicious variations from injection. For men with many abnormal sperm and prior poor ICSI IVF outcomes, IMSI offers enhanced selection, potentially increasing fertilization and normal embryo development chances.

Decade-long randomized controlled trials and systematic reviews suggest IMSI might benefit specific situations, like previous failed ICSI attempts. However, research doesn't support IMSI over standard ICSI for all infertile men. One small study showed improved pregnancy outcomes in older women, but the sample size was limited, and the IMSI-older egg link remains unclear.

Why IMSI Can Help You

Healthy pregnancies depend heavily on embryo quality, influenced by both egg and sperm quality. Abnormal sperm might create an embryo, but it's less likely to implant or may result in miscarriage.

Microscopes magnify up to 400x, but IMSI reaches 6,000x, allowing precise detection of sperm head abnormalities. Selecting sperm without these abnormalities increases the chances of better-quality embryos.

While not universally beneficial, IMSI is recommended for recurrent implantation failure, recurrent ICSI failure, or severe teratospermia (abnormal sperm shape). It's a selection tool, helping embryologists choose optimal sperm for ICSI. If sperm count or motility is already low, limiting sperm for ICSI, IMSI might not be suitable.

Studies suggest IMSI benefits specific situations like failed ICSI attempts. However, research indicates IMSI helps only certain patient groups and shouldn't replace standard ICSI.

Indications for IMSI

When Might IMSI Be Recommended?

IMSI may be indicated in these cases:

• High number of abnormal sperm detected during semen analysis;
• Repeated unsuccessful ICSI cycles;
• History of recurrent miscarriages;
• Poor quality embryos formed during previous cycles;

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Is IMSI Right for Me?

Some data suggest high-magnification sperm selection might be associated with higher pregnancy rates, lower miscarriage rates, and a decreased risk of major congenital malformations. However, randomized controlled trials lacking evidence on IMSI's benefits mean the most relevant indications remain to be determined.

Because IMSI use isn't fully evidence-based, clinics only offer it when deemed appropriate by your consultant. IMSI carries the same risks as ICSI; there are no significant added risks to the patient or embryo. The Human Fertilisation and Embryology Authority (HFEA) classifies IMSI as an add-on treatment.

How Does IMSI Work?

IMSI uses a high-power optical microscope, enhanced by digital imaging, to magnify a sperm sample over 6,000 times. This allows embryologists to detect subtle structural problems invisible under a normal microscope. They then select sperm with the most normal-shaped nuclei and highest motility.

What Are the Risks of IMSI?

It's unknown if IMSI carries greater risks than ICSI. The first ICSI live birth was in 1992, making it a relatively new technology. The procedure causes irreparable egg damage in about 5–10% of injected eggs, preventing fertilization.

Children born via IMSI have a slightly increased sex chromosome abnormality risk (1:100 vs. 1:400 for naturally conceived). Manifestations vary but may include infertility and reduced intelligence.

Some studies show a higher birth defect rate in ICSI children, particularly genital abnormalities (up to 6% vs. 3% naturally conceived). Whether this is genetic (fathers with these conditions are more likely to need ICSI) or due to the procedure is uncertain. 93% of ICSI children are healthy at birth.

IMSI is more expensive than IVF and should only be used when necessary. However, many children worldwide are conceived via IMSI.

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