**8. Conclusions**

The introduction to IMSI enabled to morphologically evaluate the individual motile sperm cell prior to its injection into the oocyte. The possibility to correlate each injected spermatozoon to the specific in vitro developing embryo has led to a better understanding of which sperm characteristics should be examined. Selecting a good-quality spermatozoon with normal morphology by using IMSI might be beneficial to embryonic development and to increased implantation and pregnancy rates. Taking into consideration the vast amount of knowledge accumulated, it seems that there is no advantage to recommend IMSI as a routine procedure for the entire populations referred to IVF-ICSI. In regard to the aforementioned studies and the experience accumulated, the authors pointed out that the following populations will have higher chances to conceive, while addressed to IMSI are couples with repeated implantation failures, cases of severe male factor infertility, advanced male age (>41 years old), and advanced maternal age (>30 years old). However, the latest should be considered in combination with deteriorated sperm quality.

**Author details**

† Director (retired)

**References**

\* and Adrian Ellenbogen2,3,4,† \*Address all correspondence to: barak\_yp@017.net.il

1 Dr Yona Barak Laboratories Ltd., Rosh Ha'Ayin, Israel

3 IVF Unit, Hillel Yaffe Medical Center, Hadera, Israel 4 Meuheded Female Health Center, Bnai-Brack, Israel

470819. DOI: 10.1155/2015/470819

Human Reproduction. 1995;**10**:1123-1129

male infertility. Fertility and Sterility. 1995;**63**:828-837

1995;**64**:982-986

2 Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Interacytoplasmic Morphologically Selected Sperm Injection: A Tool for Selecting the Best…

http://dx.doi.org/10.5772/intechopen.73388

213

[1] Palermo G, Joris H, Devroy P, Van Steirteghem AC. Pregnancies after intracytoplasmic sperm injection of single spermatozoon into an oocyte. Lancet. 1992;**340**:17-18

[2] Pereira N, Neri QV, Lekovich JP, Spandorfer SD, Palermo GD, Rosenwaks Z. Outcomes of intracytoplasmic sperm injection cycles for complete teratozoospermia: A case-control study using paired sibling oocytes. BioMed Research International. 2015; Article ID:

[3] Mansour RT, Aboulghar MA, Serour GI, Amin YM, Ramzi AM. The effect of sperm parameters on the outcome of intracytoplasmic sperm injection. Fertility and Sterility.

[4] Nagy ZP, Liu J, Joris M, Verheyen G, Tournaye H, Camus M, et al. The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters.

[5] Svalender P, Forsberg AS, Jakobsson AH, Wikland M. Factors of importance for the establishment of a successful program of intracytoplasmic sperm injection treatment for

[6] Nagy ZP, Verheyen G, Tournaye H, Van Steirteghem AC. Special applications of intracytoplasmic sperm injection: The influence of sperm count, motility, morphology, source and sperm antibody on the outcome of ICSI. Human Reproduction. 1998;**13**:143-154 [7] Oehninger S, Chaturvedi S, Toner J, Morshedi M, Mayer J, Lanzendorf S, et al. Semen quality: Is there a paternal effect on pregnancy outcome in *in-vitro* fertilization/intracy-

[8] Sukcharoen N, Sithipravej T, Promviengchai S, Chinpilas V, Boonkasemsanti W. Sperm morphology evaluated by computer (IVOS) cannot predict the fertilization rate *in vitro*

after intracytoplasmic sperm injection. Fertility and Sterility. 1998;**69**:564-568

toplasmic sperm injection? Human Reproduction. 1998;**13**:2161-2164

Yona Barak<sup>1</sup>

It is also suggested to perform an independent observational diagnosis, using high magnification for the motile spermatozoa on a processed specimen prior to the time of the ICSI/IMSI procedure. This gives the laboratory an idea about the percentage of high-quality spermatozoa. In normospermia cases, according to routine sperm analyses, it is recommended to refer the couples to IMSI only when IMSI pre-analysis demonstrated less than 7% of high-scored (score 4–6) motile spermatozoa (Barak and Ellenbogen, personal communication). Moreover, according to the current knowledge no prenatal or postnatal complications in the mothers and offspring were observed following the IMSI procedure. The effectiveness of IMSI is still controversial mainly due to variations in inclusion criteria, stimulation protocols, sperm and oocyte qualities, and many additional confounding variables frequent in the IVF cycles.

However, there is no doubt that usage of the IMSI technique definitely opened a wider door for the hope of couples in their journey to fulfill their wish for a child. Further investigations should take place, to improve our knowledge in using this technique.
