Intracytoplasmic morphologically selected sperm injection (IMSI) is a modified form of the ICSI (intracytoplasmic sperm injection) technique, however the only difference is that it carefully selects the best quality sperm by magnifying 6000 times more than the conventional ICSI method.
Patients with severe oligoasthenoteratozoospermia (low sperm count) can benefit from IMSI.
Intracytoplasmic Sperm Injection (ICSI) is a method in which a single sperm is injected into the center of the cytoplasm of the egg to increase the chances of fertilization. ICSI procedure channels only one egg and one sperm needed to produce one embryo.
IMSI Treatment Stages:
1. Medication: The woman (recipient) will be prescribed medication to help control ovulation. Medications will also be prescribed to increase the egg supply.
2. Keeping track of Progress: To keep track of the recipient’s progress, the clinic will monitor the eggs by vaginal ultrasound scans. They will also do blood tests to chart the rising levels of estrogen produced by the eggs, which will help keep track of how the eggs are maturing.
3. The woman will receive a hormone injection to help the eggs mature 34-38 hours before the eggs are to be collected.
4. Collecting the Eggs: Eggs are usually collected by the guidance of an ultrasound, which usually takes about 30 minutes. The doctor will insert a thin needle through the vagina into each ovary. The eggs will then be drawn into the needle. Eggs are collected by laparoscopy (a small telescope with a light attached). This procedure involves making a small incision in the stomach and extracting the eggs with a fine needle.
5. Collecting the Sperm: Around the same time that the eggs are collected, a sperm sample will be taken from the male partner and stored for a short time. The sperm will be washed and spun, and then the healthiest sperm will be selected to fertilize with the egg. If donor sperm is being used, the sperm will be taken from the freezer and prepared in the same way.
6. Fertilization: Once the sperm and egg are collected, they are combined in a Petri dish, and monitored for 20-40 hours. If fertilization has occurred, the resulting embryo is monitored for several days to follow its cellular division. In order for the fertilization to be successful, it must first divide into two cells, then four, and finally into eight. The embryo can then be transferred into the recipient’s uterus.
7. Transfer Embryo: The embryo transfer can occur 1-5 days after fertilization occurs, depending on factors that the couple will discuss with the embryologist, such as low sperm count and embryo development. Same day embryo transfer, in which the embryos are transferred about 4 hours after fertilization, is becoming more common since it allows recipients to undergo the procedure on an outpatient basis. Most embryologists recommend that the recipient wait until day five to transfer the embryo, which is known as the blastocyst stage. The blastocyst transfer has also become quite common as it increases chances of successful implantation and decreases the likelihood of multiple pregnancies.
8. Insemination: This process is the last stage of the IVF procedure. It is usually painless and does not require any anesthesia. The embryos are transferred into the uterus through the cervix with a catheter. Typically 2-4 embryos are transferred into the uterus to increase the chances of pregnancy. If done successfully, the patient can go home and should rest for the remainder of the day. A pregnancy test will be given 12-15 days after the embryo transfer. If the IVF is successful, a normal pregnancy can be carried out.
Risks and side effects include possible displacement of the embryos into the cervix, resulting in a lost embryo, or in the fallopian tubes, resulting in tubal (ectopic) pregnancy; multiple pregnancies. If IVF is successful, a normal pregnancy will be carried out. If IVF with ICSI results in an unsuccessful pregnancy or no pregnancy, different methods of IVF should be considered, such as Egg Donor IVF, Sperm Donor IVF or Embryo Donor IVF.
Transferring the embryo may cause mild bleeding and cramping.