title: Could sperm grade under high magnification condition predict IMSI clinical outcome?
abstract: OBJECTIVE
  The aim of this study was to examine whether injection of first-best morphology grade selected spermatozoa improves live birth rate (LBR) compared to intracytoplasmic morphologically selected sperm injection (IMSI) using second-best grade sperm.
  
  
  METHODS
  In this prospective observational study, 132 patients were enrolled. Inclusion criteria were the presence of severe male factor (normal spermatozoa <10% in fresh ejaculated semen and <10% in selected sperm according to David's classification) associated with ≤2 previous ICSI failure. Results of IMSI performed with either first- or second-best morphology grade spermatozoa (according to Vanderzwalmen's classification) were compared. IMSI attempts performed using mixed first- and second-best grade spermatozoa were excluded (n=41). The primary endpoint was LBR.
  
  
  RESULTS
  LBR following IMSI was not statistically different using first- (33.3% (13/39)) or second-best morphology grade spermatozoa (28.9% (15/52)). Our study shows that sperm grading under high magnification using Vanderzwalmen's classification is not correlated to IMSI outcome.
  
  
  CONCLUSIONS
  We do not validate Vanderzwalmen classification in our external and prospective series. These results point out the need for improving our knowledge about the impact of observed vacuoles under high magnification condition.
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France. Electronic address: christophe.sifer@jvr.aphp.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Sifer
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France.
authors.forename: Laïla
authors.initials: L
authors.lastname: El Khattabi
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Dupont
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sermondade
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France.
authors.forename: Charlène
authors.initials: C
authors.lastname: Herbemont
authors.affiliation: Service de Biostatistique et d'Informatique Médicale, Centre Hospitalier Universitaire Saint-Louis, Assistance Publique - Hôpitaux de Paris, 75475 Paris cedex 10, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.affiliation: Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France; Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cedrin-Durnerin
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Faure
authors.affiliation: Service d'Histologie-Embryologie-Cytogénétique-CECOS, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France; Unité de Recherche en Epidémiologie Nutritionnelle, UMR U557 Inserm; U1125 Inra; Cnam; Université Paris 13, CRNH IdF, 93017 Bobigny, France.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lévy
authors.affiliation: Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Grynberg
authors.affiliation: Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Poncelet
authors.affiliation: Service de Médecine de la Reproduction, Centre Hospitalier Universitaire Jean Verdier, Assistance Publique - Hôpitaux de Paris, 93143 Bondy, France.
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Hugues
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000628:therapy; D008297:Male; D008853:Microscopy; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D055101:Semen Analysis / Q000379:methods*; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013094:Spermatozoa / Q000145:classification* / Q000166:cytology; D014617:Vacuoles
keywords: High magnification; IMSI; Live birth rate; Sperm morphology grade.; Spermatozoa selection