title: Intracytoplasmic morphologically selected sperm injection results in improved clinical outcomes in couples with previous ICSI failures or male factor infertility: a meta-analysis.
abstract: The objective of this study was to perform the first meta-analysis to compare conventional intracytoplasmic sperm injection (ICSI) outcomes and intracytoplasmic morphologically selected sperm injection (IMSI) outcomes in couples with previous ICSI failures (IF) or male factor infertility (MF). A systematic review was performed by searching Medline database to identify articles reporting on the comparison between ICSI and IMSI outcomes in couples with IF or MF. The main outcome measures were the implantation, pregnancy and miscarriage rates. Thirteen studies fulfilled our predetermined criteria. The overall results of meta-analysis for implantation (OR: 2.88; CI: 2.13-3.89), pregnancy (OR: 2.07; CI: 1.22-3.50) and miscarriage rates (OR: 0.31; CI: 0.14-0.67) were in favor of IMSI in couples with IF. Additionally, the overall result of meta-analysis for implantation (OR: 1.56; CI: 1.11-2.18) and pregnancy rate (OR: 1.61; CI: 1.17-2.23) were in favor of IMSI in couples with MF. IMSI increases the odds of implantation by 50% and pregnancy by 60% in couples with MF. In light of improved clinical outcomes, we recommend promoting the IMSI method in couples with MF. Moreover, IMSI results in a 3-fold increase in implantation rate, a 2-fold increase in pregnancy rate and a 70% decrease in miscarriage rate as compared to ICSI in couples with IF, however, as no randomized evidence exists, randomized studies are needed to confirm the IMSI benefits in couples with IF.
authors.affiliation: Instituto Sapientiae-Centro de Estudos e Pesquisa em Reprodução Assistida, Rua Vieira Maciel, 62, São Paulo 04503-040, SP, Brazil; Fertility-Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, Sao Paulo 01401-002, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Junior, 61, Sao Paulo 01221-020, SP, Brazil.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Setti
authors.affiliation: Instituto Sapientiae-Centro de Estudos e Pesquisa em Reprodução Assistida, Rua Vieira Maciel, 62, São Paulo 04503-040, SP, Brazil; Fertility-Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, Sao Paulo 01401-002, SP, Brazil.
authors.forename: Daniela P A F
authors.initials: DP
authors.lastname: Braga
authors.affiliation: Fertility-Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, Sao Paulo 01401-002, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Junior, 61, Sao Paulo 01221-020, SP, Brazil.
authors.forename: Rita C S
authors.initials: RC
authors.lastname: Figueira
authors.affiliation: Instituto Sapientiae-Centro de Estudos e Pesquisa em Reprodução Assistida, Rua Vieira Maciel, 62, São Paulo 04503-040, SP, Brazil; Fertility-Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, Sao Paulo 01401-002, SP, Brazil.
authors.forename: Assumpto
authors.initials: A
authors.lastname: Iaconelli
authors.affiliation: Instituto Sapientiae-Centro de Estudos e Pesquisa em Reprodução Assistida, Rua Vieira Maciel, 62, São Paulo 04503-040, SP, Brazil; Fertility-Centro de Fertilização Assistida, Av. Brigadeiro Luis Antonio, 4545, Sao Paulo 01401-002, SP, Brazil. Electronic address: edson@fertility.com.br.
authors.forename: Edson
authors.initials: E
authors.lastname: Borges
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D010064:Embryo Implantation / Q000502:physiology; D005260:Female; D006801:Humans; D015994:Incidence; D007248:Infertility, Male / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013094:Spermatozoa / Q000166:cytology* / Q000502:physiology*; D016896:Treatment Outcome
keywords: IMSI; Implantation; MSOME; Male factor; Miscarriage; Sperm morphology