Intracytoplasmic morphologically selected sperm injection versus intracytoplasmic sperm injection: a step toward a clinical algorithm

Our group experience demonstrates a clinical advantage for IMSI procedure in patients who failed in their first ICSI or for patients who shifted between ICSI and IMSI modalities.


Anat Hershko Klement, M.D., Nira Koren-Morag, Ph.D., Pavel Itsykson, Ph.D., Arie Berkovitz, M.D.

Volume 99, Issue 5, Pages 1290-1293, April 2013



To study the advantage of IMSI versus ICSI in the first ART cycle and in consecutive cycles. Design: a cohort study.


A cohort study.


Single outpatient fertility center.


Couples presenting with male factor infertility, requiring ovum micromanipulation.


ICSI or IMSI were performed according to the couple’s choice.

Main Outcome Measures:

Clinical intrauterine pregnancies and deliveries.


A total of 1,891 IVF-ICSI cycles and 577 IVF-IMSI cycles were included. In the first IVF treatment, pregnancy rates were 46% and 47%, respectively and delivery rates: 23% versus 30%, respectively. In the second cycle to follow a failed ICSI, pregnancy and delivery rates were both significantly higher for patients who chose to shift to the IMSI technique as compared to patients who chose to go through a second IVF-ICSI cycle: 56% versus 38% pregnancy rates and 28% versus 18% delivery rates, respectively. In the following cycles a significant difference was demonstrated in both pregnancy and delivery rates in favor of patients shifting between treatments. In a multivariate analysis an approximate 3-fold increased chance existed for both pregnancy and delivery only in the case of couples failing an ICSI attempt who shifted to IMSI.


Our present experience supports refraining from repeated IMSI cycles. In light of improved pregnancy and delivery rates, we recommend promoting the IMSI method for couples who failed ICSI cycle, once or more.

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