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Infertility is becoming a common problem affecting many people around the world. Couples who cannot achieve successful results with the natural method or other treatment techniques tend to in vitro fertilization treatment. In IVF treatment, especially in cases such as unexplained infertility, successful results can be obtained in the first attempt. However, in most cases, infertility is caused by other factors, and sperm problems come first. The IMSI technique is the method developed for solving such problems.

What is IMSI?

Intracytoplasmic morphologically selected sperm injection (IMSI) is a non-surgical sperm selection process used during IVF treatment. A highly effective microscope with a magnification power of around 6000 times is used to analyze sperm. Thus, by obtaining digitally enhanced images of sperms; It enables embryologists to identify almost any structural changes and any abnormality that would not be detectable by conventional techniques. With the IMSI procedure, the composition of the sperm can be evaluated and sperm with suspected irregularities can be prevented from entering the eggs.
The IMSI procedure was developed in the early 2000s and completely changed the perspective of what top quality sperm should look like.

Why is IMSI done?
Male infertility is determined by analyzing a sperm sample. Sperm; are tested for mobility and morphological features. Since abnormal results in any of the parameters are associated with fertility problems, he may recommend IVF treatment with vaccination or microinjection (ICSI) depending on the degree of the problem. The ICSI technique, in which the sperm is injected directly into the egg, does not give as effective results as IMSI.
Achieving a healthy pregnancy largely depends on the quality of the embryo. The quality of an embryo is proportional to both egg and sperm quality. Abnormal sperm can also fertilize an egg, but such embryos have a low rate of implantation and a high rate of premature termination of pregnancy.
With IMSI, the magnification can be as high as 6000, although some sperm abnormalities can be detected using a microscope with a magnification of 400 times. Thus, abnormalities of sperm can be seen more accurately. By choosing sperm that do not contain abnormalities, there is a higher chance of creating higher quality embryos.

Who is IMSI suitable for?
The IMSI procedure is usually recommended for male factor infertility problems; Other reasons for preference are as follows:

Failure to obtain successful results with the sperm selected with the ICSI technique,
The age of the male partner is 40 and over,
Finding a high number of abnormal sperm in the sperm analysis,
Very low sperm count
Having high levels of antibodies in the semen that can affect fertilization,
Surgical removal of sperm directly from the epididymis (the spiral tube that stores sperm outside of the testicles) or from the testis,
History of recurrent miscarriage
Low quality of embryos formed in previous cycles,
higher levels of DNA fragmentation,
Increased levels of sperm aneuploidy.

How is IMSI done?

IMSI is a process in which the sperm is selected before the sperm and egg are fertilized by microinjection. This selection of sperm is done gracefully to separate impaired or abnormal sperm that may hinder pregnancy.
The IMSI technique can be applied as:
On the day of the procedure, a fresh or frozen sperm sample is requested from the man.
The sperm sample taken is examined by an embryologist specially trained in the IMSI technique with a microscope with a magnification power of approximately 6000 times. Advanced technology developed with digital imaging is used to analyze the fine structures of sperm. The internal morphology of the sperm is also examined and the sperms with abnormality are separated at this stage.
In the next process, the selected sperm and egg are fertilized by microinjection technique. Examination is done to determine which eggs are mature enough for fertilization. Using a fine glass needle, the sperms are aspirated and then injected into the selected egg. Injected eggs are cultured in the incubator for one day.
After examining the healthy embryos created, planning is made for embryo transfer.

What are the advantages and disadvantages of the IMSI technique?
The advantages of the IMSI technique are:
IMSI doubles pregnancy rates in the first trimester and reduces miscarriage rates by 60%. The chance of miscarriage can be reduced by choosing better sperm.
IMSI facilitates the interaction between spermatozoa and oocyte.
Seminal abnormalities such as decreased sperm count, motility or increased morphological defects will not be able to affect fertilization.
IMSI has been associated with a higher percentage of embryos and improved embryo quality to reach the blastocyst stage.

The disadvantages can be listed as follows:

IMSI adds approximately 5 hours of extra time to the IVF procedure. Therefore, it is not a routine examination and is preferred only in cases of recurrent IVF failure, when the sperm quality is very low.

IMSI is costly and cannot be applied in every health centre.
IMSI is more likely to cause multiple pregnancies than the microinjection technique.

Is IMSI a successful technique?

IMSI is an important technique, especially for couples who have had two or more previous failed cycles. It is associated with higher pregnancy and birth rates compared to embryos created by microinjection only.
IMSI is a non-invasive method performed on a sperm sample as an additional step in the microinjection process. The risks associated with microinjection are the same as with the IMSI technique, with no significant additional risks to the patient or embryo.

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