title: Is intracytoplasmic morphologically selected sperm injection effective in patients with infertility related to teratozoospermia or repeated implantation failure?
abstract: OBJECTIVE
  To evaluate the potential benefit of intracytoplasmic morphologically selected sperm injection (IMSI) in patients selected for either severe teratozoospermia or repeated implantation failure after conventional intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Prospective nonrandomized observational study.
  
  
  METHODS
  University hospital assisted reproduction unit.
  
  
  METHODS
  Four hundred seventy-eight patients were enrolled to evaluate ICSI and IMSI results for two indications. The first group (T) was composed of patients with severe teratozoospermia (<10% normal spermatozoa in fresh ejaculated and selected semen, according to David classification) and no or one previous ICSI failure. In the second group (IF), patients with at least two previous failed ICSI attempts were enrolled in absence of severe male factor (>10% normal spermatozoa in fresh ejaculated semen and >20% in selected sperm).
  
  
  METHODS
  ICSI/IMSI, biologic, and clinical data collection.
  
  
  METHODS
  Live-birth rate (LBR).
  
  
  RESULTS
  In group T, LBR was significantly higher when IMSI procedure was used compared with ICSI (38% [50/132] vs. 20% [25/126]). However, LBR observed in group IF was not significantly different between IMSI and ICSI procedures (21% [19/90] vs. 22% [28/130]).
  
  
  CONCLUSIONS
  IMSI procedure is a valuable option for patients with severe teratozoospermia at their first or second attempts, but it does not improve pregnancy rate in patients with repeated ICSI failures in the absence of severe male factor.
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique-Hôpitaux de Paris, Bondy, France.
authors.forename: Laïla
authors.initials: L
authors.lastname: El Khattabi
authors.forename: Charlotte
authors.initials: C
authors.lastname: Dupont
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sermondade
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Hugues
authors.forename: Christophe
authors.initials: C
authors.lastname: Poncelet
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cedrin-Durnerin
authors.forename: Rachel
authors.initials: R
authors.lastname: Lévy
authors.forename: Christophe
authors.initials: C
authors.lastname: Sifer
mesh_terms: D000328:Adult; D053713:Azoospermia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends*; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome