**4. Use of IMSI**

Intracytoplasmic morphologically selected sperm injection (IMSI) is examination of unstained spermatozoa at 6000 or higher magnification to select sperm with best morphology. It is based on a method of high magnification motile sperm organelle morphology examination (MSOME) [18]. It requires an inverted light microscope equipped with high power Nomarski optics enhanced with digital imaging. Such examination helps to identify spermatozoa with a normal nucleus and nuclear content [19]. The exact indications of IMSI [20] and usefulness [21] are debatable. Finding normal-looking spermatozoa took a minimum of 60 min, and up to 210 min, depending on the quality of the semen sample. The technique required two embryologists working together on the analysis of the same sample at the same time in order to minimize the subjective nature of sperm evaluation [22]. The IMSI procedure improved embryo development and the laboratory and clinical outcomes of sperm microinjection in the same infertile couples with male infertility and poor embryo development over the previous ICSI attempts [23]. A successful childbirth after IMSI without assisted oocyte activation in a patient with globozoospermia has been reported [24]. Randomized large-scale trials are needed to confirm the beneficial effects of IMSI in couples with poor reproductive prognoses [25].
