The aim of the present prospective study was to determine whether subtle sperm morphological characteristics affect the outcome of intracytoplasmic sperm injection (ICSI), and if so, to identify those that are relevant. For this purpose, we developed a new method, the motile sperm organelle morphology examination (MSOME). The examination is performed in real time using an inverted light microscope equipped with high-power Nomarski optics enhanced by digital imaging to achieve a magnification up to 6300x. MSOME was applied to the leftover sperm fraction selected for microinjection in 100 random couples referred for ICSI treatment at 3 major in vitro fertilization centers. We found that the morphological normalcy of the entire sperm cell, according to MSOME criteria, was positively associated with ICSI fertilization rate (area under the receiver operating characteristics [ROC] curve, 88%) but not with pregnancy outcome. The morphological normalcy of the sperm nucleus, defined by MSOME, was significantly and positively associated with both fertilization rate and pregnancy outcome (areas under the ROC curve, 72% and 74%, respectively). These findings indicate that ICSI-associated pregnancy rate may be affected by subtle morphological malformations of the sperm nucleus, which may remain undetected by the embryologist during the routine selection procedure.

Real-time fine morphology of motile human sperm cells is associated with IVF-ICSI outcome.

The aim of the present prospective study was to de- termine whether subtle sperm morphological characteristics affect the outcome of intracytoplasmic sperm injection (ICSI), and if so, to identify those that are relevant. For this purpose, we developed a new method, the motile sperm organelle morphology examination (MSOME). The examination is performed in real time using an in- verted light microscope equipped with high-power Nomarski optics enhanced by digital imaging to achieve a magnification up to 6300. MSOME was applied to the leftover sperm fraction selected for mi- croinjection in 100 random couples referred for ICSI treatment at 3 major in vitro fertilization centers. We found that the morphological normalcy of the entire sperm cell, according to MSOME criteria, was positively associated with ICSI fertilization rate (area under the re- ceiver operating characteristics (ROC) curve, 88%) but not with preg- nancy outcome. The morphological normalcy of the sperm nucleus, defined by MSOME, was significantly and positively associated with both fertilization rate and pregnancy outcome (areas under the ROC curve, 72% and 74%, respectively). These findings indicate that ICSI-associated pregnancy rate may be affected by subtle morpho- logical malformations of the sperm nucleus, which may remain un- detected by the embryologist during the routine selection procedure.

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Breakthroughs in Andrology Real-Time Fine Morphology of Motile Human Sperm Cells is Associated With IVF-ICSI Outcome

BACKGROUND: Our preceding studies have already demonstrated the advantage of intracytoplasmic morphologically selected sperm injection (IMSI) over the conventional IVF-ICSI procedure in terms of pregnancy rate. This study was undertaken to determine whether the increased pregnancy outcome was attributable to the preferred nuclear morphology of the selected spermatozoa, and not to the special sperm preparation technique modified by IMSI. METHODS: Comparison between two matched IMSI groups, i.e. negative comprising 38 cycles, where no spermatozoa with intact nuclei were available for microinjection; and positive, involving ovum microinjection by spermatozoa with strictly defined morphologically normal nuclei. RESULTS: Implantation and pregnancy rates were significantly higher, and abortion rates significantly lower, in the positive group compared with the negative group (25.0 6 25.9 versus 5.9 6 12.9%, F 5 15.8, P # 0.01; 52.6 versus 18.4%, x 2 5 9.7, P # 0.01; and 10.0 versus 57.1%, x 2 5 7.1, P # 0.02, respectively). CONCLUSIONS: Implantation and pregnancy by ICSI is

/pdf/the-morphological-normalcy-of-the-sperm-nucleus-and-39dyjs9qn3.pdf

The morphological normalcy of the sperm nucleus and pregnancy rate of intracytoplasmic injection with morphologically selected sperm

To the Editor: Intracytoplasmic injection of sperm is the recommended treatment for male infertility, associated with an average pregnancy rate per cycle of about 30 percent.1 Although sperm count and motility were found to have no effect on the outcome of intracytoplasmic sperm injection,2 scanning and transmission electron microscopy indicated that the achievement of pregnancy may depend on normal morphology of the sperm nucleus.3 We therefore introduced the motile-sperm organelle-morphology examination (MSOME), by which the fine nuclear morphology of motile spermatozoa is examined in real time with an inverted light microscope equipped with high-power differential interference contrast (Nomarski/DIC) optics (magnification, . . .

Selection of Spermatozoa with Normal Nuclei to Improve the Pregnancy Rate with Intracytoplasmic Sperm Injection

In previous studies, a new IVF method of intracytoplasmic morphologically selected sperm injection (IMSI) was introduced, based on motile sperm organellar morphology examination (MSOME). It was concluded that microinjection of morphologically selected sperm cells with strictly normal nucleus, defined by MSOME, improves IVF–ICSI outcome. The aim of the present study was to confirm this conclusion in new, enlarged study groups. Comparison between 80 couples, who underwent an IVF–IMSI trial, with matched couples, who underwent a standard IVF–ICSI procedure, confirmed that pregnancy rate following IVF–IMSI was significantly higher, and abortion rate significantly lower than in the routine IVF–ICSI (60.0 versus 25.0%, and 14 versus 40% respectively, P ≤ 0.05). Another comparison was performed between matched IMSI groups, where embryos were obtained from microinjection by spermatozoa with a morphologically normal nucleus (‘best' group, n = 70) and a ‘second best' group was selected, where embryos were obtained from microinjection of spermatozoa with minimal morphological impairment, since no other sperm cells were available. It was confirmed that microinjection by ‘second best ‘ spermatozoa result in significantly lower pregnancy and delivery rates and significantly higher abortion rates than microinjection with ‘best' spermatozoa (25.7 versus 58.2%, P ≤ 0.01; 17.1 versus 52.8%, P ≤ 0.01, and 33.3 versus 9.7%, P ≤ 0.02 respectively). The present study has strengthened previous conclusions.

How to improve IVF-ICSI outcome by sperm selection.

Summary. Management of male infertility has recently shifted from treatment of the subfertile man towards techniques of assisted reproduction (ART). This study aimed to evaluate the possible role of the ultramorphological status of the spermatozoon with respect to sperm selection in vivo and prediction of ART success. Ultramorphological sperm parameters were assessed retrospectively for 92 males with sufficient sperm density (107 spermatozoa ejaculate−1) whose wives conceived following a stepwise discarding of the female genital tract barriers, using intra-uterine insemination (IUI) (n= 26), in vitro fertilization (IVF) (n= 45) or intracytoplasmic sperm injection (ICSI) (n= 21). In parallel, sperm samples of 71 fertile males were examined. Normal ultramorphology of all head and tail subcellular organelles was found to be essential for the ability of spermatozoa to pass the lower female genital tract. The ultramorphological migration threshold for this barrier is apparently higher than that essential for oocyte fertilization. No specific indication associated with passage through the upper genital tract was found. A high prevalence of axonema defects was found to impair the ability of sperm cells to penetrate the oocyte investment. The natural fertility index, based on routine sperm parameters and the ultrastructural status of the spermatozoon's subcellular organelles was confirmed to be beneficial for directing patients to ART. A discriminative score based on axonema integrity was found to contribute additional information for the first choice decision between conventional ART and ICSI (75% prediction ability). Thus it may be helpful in finding the simplest and least expensive procedure with the greatest long-term chance for pregnancy.

Y. Beyth

Papers

ART success and in vivo sperm cell selection depend on the ultramorphological status of spermatozoa.