Normal morphology of motile human sperm cells is related to the success of in vitro fertilization using the micromanipulation technique (IVF-ICSI)
Selection of sperm cells with a normal nucleus increases the pregnancy rate for in vitro fertilization using the micromanipulation technique (IVF-ICSI)
A higher pregnancy rate with in vitro fertilization using the morphological selection method (IMSI) compared with the conventional method (ICSI)
Sperm cell nucleus normalcy and the pregnancy rate for in vitro fertilization using the morphological selection and micromanipulation method (IMSI)
Does the presence of nuclear vacuoles in sperm cells injected into eggs during in vitro fertilization using the micromanipulation technique affect its outcome?
How can the outcome of in vitro fertilization using the micromanipulation technique be improved by pre-selection of sperm cells?
Is the fine morphology of the sperm cell nucleus impaired as a result of the sperm cells' incubation at 37ºC under laboratory conditions?
Normal morphology of motile human sperm cells is related to the success of in vitro fertilization using the micromanipulation technique (IVF-ICSI)
The research question: The MSOME method enables defining the morphological normalcy of six sperm cell organelles as observed at high magnification (x6000) using 24 characteristics. Is there a relation between the morphology of the sperm cell and/or its organelles and the success rate of in vitro fertilization using the micromanipulation technique?

Results: One hundred couples who were treated at 3 different IVF centers (2 in Israel, 1 abroad) using the conventional micromanipulation technique were chosen. MSOME examination revealed that only normal sperm cell nucleus morphology was correlated with the success rate of pregnancies at a prediction level of 74%. All 28 of the couples who conceived exhibited a high percentage of sperm cells with a normal nucleus.

Message: The sperm cell nucleus morphology is very important for achieving pregnancies using the ICSI micromanipulation technique. The next stage should therefore be injection of sperm cells with a normal nucleus only into eggs.

This article was published in the most prestigious journal in andrology (male fertility) in January/February 2002 and was labeled "a breakthrough article"
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Selection of sperm cells with a normal nucleus increases the pregnancy rate for in vitro fertilization using the micromanipulation technique (IVF-ICSI)


The research question: It is known that the quantity of sperm cells in the semen and their motility are not important for in vitro fertilization using the micromanipulation technique, since a single spermatozoon is injected into the egg. Is it possible that the morphology of the nucleus of the selected cell is important and affects the fertilization outcome?

Results: An optical system that can magnify the sperm cell more than 6000 times was constructed in order to examine the quality of the nucleus before its injection into the egg (IMSI/MSOME). 24 couples who in the past failed at least 5 consecutive times were selected for this experiment. A male factor in the sperm cell quality was identified in these men and the women's age was less than 37. The couples underwent one treatment cycle using the new method and a pregnancy rate of 58% was achieved.

Message: The morphology of the nucleus of the sperm cell selected for injection using the micromanipulation technique is very important for achieving a pregnancy and the new method (IMSI) should therefore be recommended for couples who in the past failed in the conventional micromanipulation technique (ICSI).

This article was published in the most prestigious scientific-medical journal in the world in October 2001.
Due to copyrights, please apply to the journal's editorial board if you wish to read the complete manuscript:
"Selection of spermatozoa with normal nuclei to improve the pregnancy rate with intracytoplasmic sperm injection" (New England Journal of Medicine 2001; 345:1067).
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A higher pregnancy rate with in vitro fertilization using the morphological selection method (IMSI) compared with the conventional method (ICSI)

The research question: Is it possible to verify the outcome of in vitro fertilization with the new IMSI technique (in which only sperm cells with a normal nucleus are chosen at a magnification of x6000) versus the conventional method (ICSI) by prospective and comparative research in couples who failed in ICSI in the past?

Results: One hundred couples who in the past failed at least twice with the conventional ICSI method were selected. Half underwent an additional ICSI and the other half underwent one cycle of the new IMSI technique. The pregnancy rate with the conventional method was the customary 30%, whereas the rate with the new method was doubled and reached 66%. In parallel, the abortion rate using the conventional method was 33% whereas with the new method it was only 9%.

Message: Injection of a sperm cell with normal morphology according to the IMSI criteria into an egg significantly improves the micromanipulation outcome.

This article was published in the most prestigious scientific journal in the field of fertility in the United States.
Due to copyrights, please apply to the journal's editorial board if you wish to read the complete manuscript:
"Pregnancy rates are higher with intracytoplasmic morphologically selected sperm injection than with conventional intracytoplasmic injection" (Fertility and Sterility 2003; 80:1413-9)
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Sperm cell nucleus normalcy and the pregnancy rate of in vitro fertilization using the morphological selection and micromanipulation method (IMSI)
The research question: The following question is asked in light of previous results in which we proved that micromanipulation carried out using the IMSI technique has advantages over the conventional micromanipulation technique (ICSI): Is this advantage perhaps achieved because of improvements that were introduced into the new process and not really because of the specific quality of the sperm cell nucleus?

Results: Seventy-six couples were selected. All underwent micromanipulation with the IMSI technique. Sperm cells with a normal nucleus were selected in 38 couples in order to inject them into the eggs (positive sub-group). Second-choice sperm cells were selected in the other 38 couples because no sperm cells with a normal nucleus were found (negative sub-group). The implantation and pregnancy rates achieved in the positive sub-group were 4.2 and 2.8 times higher, respectively, than in the negative sub-group and the abortion rate was 10% in the positive sub-group and 57% in the negative sub-group.

Message: A sperm cell with a normal nucleus has significant advantages in the micromanipulation technique for the implantation of embryos in the uterus, for the achieved pregnancy rate and for reducing the abortion rate. More time should therefore be invested in a search among the man's sperm cells with the aim of finding motile sperm cells with a normal nucleus.
This article was published in a most prestigious journal in the field of fertility.
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Does the presence of nuclear vacuoles in sperm cells injected into eggs during in vitro fertilization using the micromanipulation technique affect its outcome?
The research question: It is difficult to find sperm cells with a normal nucleus in about 12% of the couples referred for IMSI even after a prolonged search. It was therefore suggested that second-choice sperm cells should be selected in these couples, in which the external shape of the nucleus is normal but a vacuole is found within the nucleus. Can cells with such a defect influence the outcome of micromanipulation using the new IMSI technique?

Results: Fifty-six couples who were referred for the IMSI method were selected. A sperm cell with a normal nucleus was injected into eggs in 28 couples (positive sub-group). In the other 28 couples there was no choice but to inject sperm cells with vacuoles (negative sub-group). The pregnancy rate achieved in the negative sub-group was significantly lower (18%) than in the positive sub-group (50%). The abortion rate was higher (80%) than in the positive sub-group (7%).

Message: Sperm cells with a nuclear vacuole may cause abortions in the first trimester of pregnancy. Their injection into eggs should therefore be avoided.
This article was published in the following journal:
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How can the outcome of in vitro fertilization using the micromanipulation technique be improved by pre-selection of sperm cells?
The research question: Can the advantages of micromanipulation using the new IMSI technique versus the conventional ICSI method be scientifically reinforced by a comparative study of larger groups?

Results: The advantage of the IMSI method over ICSI in increasing the pregnancy rate was verified in a comparative study carried out among 160 couples: A pregnancy rate of 60% was achieved in 80 couples who underwent an IMSI cycle compared with 80 other couples who were treated by the conventional method, where only 25% pregnancies was achieved. Another study compared 70 other couples in whom sperm cells with a normal nucleus were injected compared with 70 other couples in whom second-choice sperm cells were injected. In this study it was again proven that a higher pregnancy rate of 58.2% was achieved in the group in which sperm cells with a normal nucleus were injected versus 25.7% in the group in which second-choice sperm cells were injected. Furthermore, the abortion rate in the group in which first-choice sperm cells were injected was 9.7% compared with 33.3% in the group in which second-choice sperm cells were injected.

Message: A sperm cell with a normal nucleus observed at high magnification using the IMSI/MSOME technique has a great advantage for success of in vitro fertilization using the micromanipulation technique.
Due to copyrights, please apply to the journal's editorial board if you wish to read the complete manuscript:
(Reproductive BioMedicine Online 2006; 12:634-638)
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Is the fine morphology of the sperm cell nucleus impaired as a result of the sperm cells' incubation at 37ºC under laboratory conditions?
The research question: Is the morphological quality of the sperm cell nucleus impaired during treatment in the laboratory at body temperature, 37ºC?

Results: A significant decrease in the percent of cells with a normal nucleus occurs after a two-hour incubation of sperm cells at 37ºC, concomitantly with an increase in the percentage of cells with a nuclear vacuole. Injection of such cells into eggs may decrease the pregnancy rate and increase the abortion rate.

Message: If treatment in any laboratory that treats human sperm cells is carried out at 37ºC then it should be ended within two hours. If this treatment takes longer it should be carried out at 21ºC.
Due to copyrights, please apply to the journal's editorial board if you wish to read the complete manuscript:
"Is fine morphology of the human sperm nuclei affected by in vitro incubation at 37oC?"
(Fertility and Sterility 2007)
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