An Open Prospective Study on Whether Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) Offers a Better Outcome Than Conventional Intracytoplasmic Sperm Injection (ICSI)
Open accessAbstract
Objective To differentiate the in vitro fertilization (IVF) outcomes between the two procedures, intracytoplasmic morphologically selected sperm injection (IMSI) and intracytoplasmic sperm injection (ICSI) in terms of relation to chemical pregnancy percentage, clinical pregnancy, live birth, miscarriage, and fertilization rates, respectively. Patients and methods This Open Prospective clinical trial was conducted during the period between Jan 2016 and Dec 2017 at one IVF unit. A total of 446 ICSI cycles and 79 IMSI cycles were conducted. Females were divided into four subgroups according to age. Results The study involved 525 couples (446 first trial ICSI cycles) and (79 first trial IMSI cycles). ICSI was statistically better than the IMSI in relation to the chemical pregnancy, clinical pregnancy (CPR), live birth (LBR), and fertilization rates, respectively (p < 0.05). However, there were no statistically significant differences between the ICSI and IMSI in relation to the miscarriage rate. There were statistically significant differences favoring ICSI in all subgroups except 35-37, in relation to chemical pregnancy; and in the 38-40 and >40 subgroups in relation to CPR. There were no statistically significant differences in these subgroups regarding the live birth, miscarriage, or fertilization rates. Conclusions This study showed that IMSI is not superior to conventional ICSI at the first attempt. Based on the findings in this study, we would not advise couples to choose IMSI at their first treatment attempt.
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The first study [103] contained numerous factors of bias and the study design did not allow a conclusion as to the predictive value of sperm morphology analysis before ICSI.
“The first one [103] contained numerous factors of bias and the study design did not allow a conclusion as to the predictive value of sperm morphology analysis before ICSI.”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [103]
The Conclusions (page unavailable) acknowledge limitations of the open prospective design and unequal ICSI and IMSI group sizes. However, the paper does not say that numerous biases prevented a conclusion about the predictive value of sperm morphology analysis before ICSI; it studied outcomes of two injection procedures and drew a conclusion about their relative benefit. (LLM, conf=0.79)
Experimental — accuracy not yet measuredOnly two studies found an impact of teratozoospermia on pregnancy rates after ICSI, and they were Grade 1.
“Only two studies found an impact of teratozoospermia on pregnancy rates after ICSI, and they were Grade 1 [102, 103].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [103]
The Introduction and Discussion associate sperm-head abnormalities with lower pregnancy rates, but neither section reports an analysis of teratozoospermia and pregnancy rates after ICSI. A search for teratozoospermia and Grade 1 studies found no passage establishing that only two studies found such an impact or that this study was one of them. (LLM, conf=0.73)
Experimental — accuracy not yet measuredIn the first study [103], the fertilisation failure rate was very high (33 of 120).
“Of note, in this study the fertilisation failure rate was very high (33 of 120) [103].”
From Recommendations for Human Sperm Morphology Assessment in 2025: An Expert Review From the French BLEFCO Group (2026) · cites this paper as [103]
The Results (page unavailable) report fertilization rates for 525 couples, including 446 in the ICSI group and 79 in the IMSI group, but do not report 33 fertilization failures among 120 cases. Searches for “33 of 120” and “fertilization failure” did not locate that figure in our copy. (LLM, conf=0.78)
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Research works printed but not linked: 28
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Cited by
Sorted by citations
Gatimel, N., Barbotin, A., Mery, L., Beauvillard, D., Bendayan, M., Boursier, A., Boueilh, T., Pereira, B., Chammas, J., Jacquet, J., et al. (2026) · Andrology · doi:10.1111/andr.70134 · Cited by 2 · see citing works
- Authors
- Moubasher, A., Abdel-Raheem, T., Ahmed, H., Salem, A., Doshi, A., & Abdel Raheem, A.
- Affiliations
- University College Hospital (GB)
- Corresponding author
- Moubasher, Amr
- ORCID
- Moubasher, Amr
- Venue
- Cureus
- Published
- 2021-11-01
- Volume
- 13
- Issue
- 11
- Pages
- e19181-e19181
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC8560014
- OpenAlex
- W3210422627
- Cited by
- 2
- References
- 0
- Citations by year
- 2024: 1 · 2023: 1
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- intracytoplasmic morphologically selected sperm injection, intracytoplasmic sperm injection, IVF outcomes, chemical pregnancy, clinical pregnancy rate, live birth rate, miscarriage rate, fertilization rate, maternal age
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