ObjectiveThe aim of the study was to compare between intracytoplasmic morphologically selected sperm injection (IMSI) and conventional intracytoplasmic sperm injection (ICSI) as regards laboratory and clinical outcomes in couples with severe oligoastheno-teratozoospermia (OAT). Design This was a prospective, nonrandomized, controlled clinical trial. SettingThe study was conducted in the Agial ICSI/IVF Center. Materials and methods A total of 1729 couples with severe OAT were enrolled: 1356 couples were submitted to routine ICSI (group I) and 373 couples were submitted to IMSI (group II) after they had been counselled about the possible role of the IMSI technique in increasing pregnancy rates. For IMSI, spermatozoa were selected at 6600 Â magnification using an inverted microscope. For conventional ICSI, spermatozoa were selected at 400 Â magnification. Main outcome measures Laboratory (fertilization rate, embryo quality, number of embryos transferred) and clinical outcomes (clinical pregnancy rate) were compared between the two groups. Both groups were comparable regarding the number of mature (MII) oocytes collected (P = 0.36) and the total number of embryos transferred (P = 0.202). No statistically significant difference was observed between the two groups regarding rates of fertilization (P = 0.946), with a mean ± SD of 63.47 ± 25.15% in group I and 64.69 ± 22.66% in group II. However, a statistically significant difference (Po0.001) was present regarding clinical pregnancy rates, 44 versus 57% in groups I and II, respectively. There was a lower number of cycles with no embryo transfer in the IMSI group versus the ICSI group (4.3 vs. 6.7%), but the difference was statistically insignificant (P = 0.086). Major conclusionOur results suggest that IMSI provides a significant improvement in clinical pregnancy rates compared with ICSI in couples with severe OAT.
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