Poor-responder patients do not benefit from intracytoplasmic morphologically selected sperm injection

Abstract

Purpose To compare the outcomes of ICSI and IMSI in women presenting with poor ovarian response. Methods Data of IMSI cycles performed from January 2011 to December 2013 were included in this retrospective cohort study. Patients were divided into two groups: normoresponder patients (NR group; patients with>4 oocytes retrieved) and poor-responder patients (PR group; patients with≤4 oocytes retrieved). Patients who underwent IMSI were matched with patients who underwent ICSI in the same period. The ICSI and IMSI outcomes were compared in the NR and PR groups. Results A total of 414 matched cycles were included in this study. The NR group comprised 324 cycles (164 ICSI and 160 IMSI cycles), and the PR group comprised 90 cycles (43 ICSI and 47 IMSI cycles). In the NR group, no significant differences were observed between the ICSI-and IMSI-treated couples regarding cycle outcomes. In the PR group, fertilisation rate was significantly lower in IMSI-treated couples (53.9 %± 36.7 % vs. 79.8 %±29.3 %). The proportion of cycles with embryo transfer (57.4 vs. 79.1 %) and the number of transferred embryos (1.5±0.8 vs. 1.9±0.7) were significantly lower in IMSI compared with ICSI. Implantation, pregnancy and miscarriage rates were similar when ICSI or IMSI were performed. Conclusions Our results suggest that unselected couples undergoing ICSI that present with poor ovarian response to controlled ovarian stimulation do not benefit from sperm selection under high magnification prior to ICSI.

RETRACTED ARTICLE: Intracytoplasmic morphologically selected sperm injection versus conventional intracytoplasmic sperm injection: a randomized controlled trial

“…However, those results were not obtained in a randomized populations resulting potentially biased by several confounders [ 32 ]. Finally, more recently, IMSI was also studied in couples with women with poor ovarian response to gonadotropin stimulation [ 33 ] or with advanced age [ 6 ]. In particular, poor responders did not benefit from sperm selection under high magnification prior to ICSI [ 33 ], whereas IMSI resulted in an improved embryo quality and in a 9-fold increase in the clinical pregnancy rate in selected couples with advanced maternal age and good ovarian response [ 23 ].…”

Predicting the clinical outcome of ICSI by sperm head vacuole examination

“…Moreover, regardless of the technique used, sperm morphology assessment was not predictive of delivery or no delivery as clinical outcomes of ICSI. In line with this observation, the study by Setti et al resulted in similar findings, as they found that implantation, pregnancy, and miscarriage rates were similar after ICSI or IMSI in low and normo-responders, without any influence of age or ovarian deficiency [Setti et al 2015].…”

“…Also, we deliberately limited the inclusion to male infertility involving only ICSI. We excluded all female factors that could affect ICSI outcomes (e.g., females > 38 years of age, endometriosis, uterine and fallopian tube malformations, or infections), thereby minimizing confounding factors, even though some authors have concluded that there is no difference in clinical outcomes after IMSI or ICSI for patients with a poor ovarian response due to age or endocrine factors [Setti et al 2015]. Moreover, in some predictive studies, normal cases have also been included that could present some limitations to the interpretation of the results.…”

“…Since then, few methodologically well-conducted studies have been published regarding the relevance of high magnification examination of injected spermatozoa, and controversy has persisted in this regard. Some authors have reported results favoring IMSI over ICSI in light of increased implantation and pregnancy rates and, in parallel, a decreased risk of miscarriage [Antinori et al 2008;Souza Setti et al 2010;Setti et al 2013;Setti et al 2014b;Setti et al 2015]. For others, no difference was seen between ICSI and IMSI in regard to the same assessment parameters [Balaban et al 2011;Teixeira et al 2013;Ebner et al 2014;Gatimel et al 2016].…”

Novel Techniques of Sperm Selection for Improving IVF and ICSI Outcomes

“…Thus, Leandri et al (2013), having examined 458 couples, did not find significant differences between IMSI or ICSI in the reproductive outcome, regardless of the initial characteristics of semen regarding DNA fragmentation, chromatin compaction, morphology, or motility. Setti et al (2015) showed no benefits of IMSI for couples with poor ovarian response. In contrast, Shalom-Paz et al (2015) reported that IMSI significantly increased implantation and clinical pregnancy rates in patients with repeated IVF-ICSI failure.…”