A new real-time morphology classification for human spermatozoa: a link for fertilization and improved embryo quality

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Purpose Various time-lapse studies have postulated embryo selection criteria based on early morphokinetic markers. However, late paternal effects are mostly not visible before embryonic genome activation. The primary objective of this retrospective study was to investigate whether those early morphokinetic algorithms investigated by time-lapse imaging are reliable enough to allow for the accurate selection of those embryos that develop into blastocysts, while of course taking into account the correlation with the type of injected spermatozoa. Methods During a period of 18 months, a total of 461 MII oocytes from 43 couples with severe male factor infertility and previous Bexternal^IVF failures after cleavage-stage embryo transfer (ET) were fertilized by intracytoplasmic morphologically selected sperm injection (IMSI). Thereof, 373 embryos were monitored in a time-lapse incubator until ET on day 5. Blastocyst outcome in combination with three previously postulated MKc (cc2: t3-t2, 5-12 h; t3, 35-40 h; t5, 48-56 h) and the morphology of the selected sperm were analyzed. Results A significant increase in the rate of blastocysts (54.0 vs. 36.3 %; P<0.01) and top blastocysts (25.3 vs. 10.8 %; P<0.001) was observed in the group of those meeting all three morphokinetic criteria (MKc3). However, MKc3 were only met in 23.3 % of all embryos. Moreover, TBR was influenced by the type of injected spermatozoa. In both groups, TBR decreased dramatically (MKc3, 35.0 vs. 17.0 %; MKc<3, 14.2 vs. 8.4 %) when class II/III sperm instead of class I were injected. Conclusion Early morphokinetic parameters might give some predictive information but fail to serve as a feasible selective tool for the prediction of blastocyst development given the influence of the type of spermatozoa injected.

Section: Discussionmentioning

confidence: 81%

“…It has been reported that the negative impact of large nuclear vacuoles (LNV) is perceptible after the onset of the EGA, leading to reduced blastocyst formation [28][29][30][31]. Moreover, LNV also affect ongoing pregnancy rates [31][32][33][34], miscarriage rates [31,33,[35][36][37], and malformation in offspring [38,39].…”

Section: Introductionmentioning

confidence: 99%

The impact of paternal factors on cleavage stage and blastocyst development analyzed by time-lapse imaging—a retrospective observational study

Neyer

Zintz

Stecher

et al. 2015

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“…With the introduction of the MSOME, it is now possible to examine the sperm morphological normalcy at the sub-cellular level [1]. The objective of this study was to identify if there is a connection between the incidence of [2,3,26]. We have observed that the incidence of LNV predicts implantation, pregnancy and miscarriage rates in couples undergoing ICSI.…”

Section: Discussionmentioning

confidence: 99%

“…A morphological normal spermatozoon analysed by MSOME is defined as having a normal head with no vacuoles or fewer than two small vacuoles that occupy for less than 4 % of the head's cross-sectional area [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

The prevalence of sperm with large nuclear vacuoles is a prognostic tool in the prediction of ICSI success

Setti

Braga

Vingris

et al. 2013

Purpose To investigate if there is a correlation between the prevalence of sperm with large nuclear vacuoles (LNV) and intracytoplasmic sperm injection (ICSI) outcomes. Methods Two hundred male patients undergoing ICSI had their sperm morphology evaluated through motile sperm organelle morphology examination (MSOME) and the percentage of LNV sperm was recorded and correlated to the ICSI outcomes.Results The percentage of sperm with LNV negatively influenced the blastocyst formation (S: 16.9, R 2 : 20.5 %, p=0.004) and implantation (S: 34.7, R 2 : 26.2 %, p=0.001). There were significant differences in the percentage of sperm with LNV between patients in which pregnancy was achieved or not (22.2 % vs. 28.4 %, p<0.001) and in patients with ongoing pregnancy or not (22.4 % vs. 28.5 %, p<0.001). The incidence of sperm with LNV was determinant to the decreased odds of pregnancy (OR: 0.74, p<0.001) and increased odds of miscarriage (OR: 1.46, p<0.001). The area under the curve (AUC) was sufficient to distinguish between couples which did achieve pregnancy or not (AUC: 0.922, p<0.001).Conclusions The MSOME is a prognostic tool in the prediction of ICSI success and could be used to select patients that should have their sperm selected by MSOME for ICSI.

“…Except for two studies [23,28], IMSI does not improve the morphology of early embryos [14,19,21,22,29]. However, an increase of development at the blastocyst stage using IMSI has been demonstrated by some authors [28,30,31], although randomization at the oocyte level did not confirm this finding [22].…”

Section: Nsmentioning

confidence: 94%

Intracytoplasmic morphologically selected sperm injection (IMSI) does not improve outcome in patients with two successive IVF-ICSI failures

Gatimel

Parinaud

Léandri

2016

Purpose Assessment of sperm morphology has been reconsidered since 2001 with the development of motile sperm organelle morphology examination (MSOME). This observation technique that combines high magnification microscopy and the Nomarski interference contrast makes it possible to select spermatozoa with as few vacuoles as possible before microinjection into the oocyte (intracytoplasmic morphologically selected sperm injection, IMSI). More than 10 years after the development of IMSI, the indications of the IMSI technique and its ability to increase pregnancy and/ or birthrates (compared with conventional ICSI) are still subject to debate. We aimed to better define the interest of IMSI in the third attempt. Methods We assessed the benefit of IMSI by carrying out a retrospective comparative study between IMSI and conventional ICSI during a third ART attempt. Two hundred sixteen couples with two previous ICSI failures were studied between February 2010 and June 2014. Results IMSI did not significantly improve the clinical outcomes compared with ICSI, either for implantation (12 vs 10 %), clinical pregnancy (23 vs 21 %), or live birth rates (20 vs 19 %).Conclusion This study provides supplementary arguments for not achieving IMSI procedure in the third attempt after two previous ICSI failures.