Idiopathic infertility is described as the failure to conceive after at least a year of unprotected intercourse in the absence of known pathologies. The proportion of patients attending for assisted reproduction that are diagnosed with idiopathic infertility is currently about 25-30%. As research and clinical techniques advance, this number tends to decline as causes are discovered. However, these groups of patients remain difficult to treat with assisted reproductive technologies. A recent probable cause of male-factor infertility has been attributed to the presence of high levels of fragmented DNA in spermatozoa. These data indicate that apparently normal spermatozoa often fertilise the oocyte creating an embryo in which the male genome is damaged to the extent that implantation and formation of a healthy foetus cannot occur. Although fragmented DNA in spermatozoa can be diagnosed, techniques enabling the selection of normal spermatozoa from the population contained within an ejaculate are still experimental. Intracytoplasmic morphology-selected sperm injection (IMSI) is a procedure in which spermatozoa are digitally analysed prior to injection into the oocyte. This increases the chance of selecting a good sperm, but physiological selection is not carried out. Here, we combine physiological pre-selection of spermatozoa with IMSI for patients with idiopathic infertility. 290 patients, attending for assisted reproduction, were prepared for oocyte retrieval using standard controlled ovarian hyperstimulation protocols. Spermatozoa were preselected for ICSI with either digitalised morphological selection (IMSI) or IMSI combined with hyaluronic acid (HA) pre-selection techniques (pIMSI). Biological and clinical parameters were recorded and the clinical pregnancy rate noted. HA- pre-selection of mature spermatozoa led to a significant increase in pregnancy and implantation rates in patients treated with IMSI. These data suggest that the combination of HA pre-determination of spermatozoa and advanced morphological analysis enables sperm selection on both a physiological and morphological basis and increases the probability of selecting a high quality spermatozoa. Physiological IMSI (pIMSI) Improves Results Obtained with IMSI in Patients with Idiopathic Infertility: Wilding M, Coppola G, Fabozzi G, Scotto di Frega A, Di Matteo L, Dale B.
Last date updated on June, 2014