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IMSI - Intra-cytoplasmic Morphologically Selected Sperm Injection - Stephen Harbottle imsi workshop presentation march 2011
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IMSI - Intra-cytoplasmic Morphologically Selected Sperm Injection - Stephen Harbottle imsi workshop presentation march 2011

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IMSI - Stephen Harbottle imsi workshop presentation march 2011 - IMSI takes ICSI to the next level. ICSI involves injecting sperm directly into your egg, before we transfer it into your womb. During …

IMSI - Stephen Harbottle imsi workshop presentation march 2011 - IMSI takes ICSI to the next level. ICSI involves injecting sperm directly into your egg, before we transfer it into your womb. During IMSI a very high power microscope to magnify the sperm around 7000 times. This allows us to see in great detail how the sperm looks and to select the best sperm for the ICSI procedure. IMSI is a very new development and is showing promise for a specific group of patients. Once the best sperm has been selected the IMSI procedure is carried out in exactly the same way as ICSI.

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  • 1. MRMC 2011 IMSI Workshop; use of the RI System Stephen J. Harbottle Lead Clinical Embryologist Cambridge IVF Creating your future
  • 2. Introduction MRMC 2011 • ICSI is a well established technique – First pregnancy reported in 1992 • IMSI is a natural extension to ICSI – MSOME to actively select sperm for injection – Use of high power microscopy and digital imaging • Optimise procedure to minimise environmental stress • Identify appropriate IMSI patient group – Maximise success rate Cambridge IVF Creating your future
  • 3. MSOME MRMC 2011 • Motile Sperm Organelle Morphology Examination (MSOME) is aimed to define the state of 6 sub cellular organelles; – Acrosome, Post Acrosomal lamina, Neck, Mitochondria, Tail, nucleus Cambridge IVF Creating your future
  • 4. Defining the ‘Normal Sperm’ MRMC 2011 • Criteria for Morphologically Normal Nucleus – Smooth, symmetric, and oval configuration • Shape – – – – Average length 4.75 ± 0.28 μm Long > 5.31 μm | Short<4.19 μm Average width 3.28 ±0.20 μm Narrow < 2.88 μm | Wide >3.68 μm • Content – No extrusion or invagination of the nuclear chromatin mass – No vacuoles with diameter greater than 0.78 ±0.18 μm Cambridge IVF Creating your future
  • 5. Significance of Nuclear Normalcy MRMC 2011 • Normalcy of the sperm NUCLEUS was found to be a significant factor in pregnancy occurrence by ICSI procedure IMSI ICSI Pregnancy Rate (%) 50% 25% Abortion Rate (%) 13% 33% Bartoov , B et al. Fertility and Sterility. 2003 Dec;80(6) Cambridge IVF Creating your future
  • 6. Examples of Vacuolation MRMC 2011 Cambridge IVF Creating your future
  • 7. Grade Description MRMC 2011 I II <2 Small Vacuoles III >2 small or >=1 large Vaculoes IV Cambridge IVF Creating your future No Vacuolation Large Vacuole and other head abnormalities Vanderzwalmen et al, 17(5): 617-627, 2008
  • 8. IMSI - Technical Development MRMC 2011 • Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) • Clinical use first reported in 20011 – Oil Immersion x150 Lens1, DIC Illumination1 – Optimum magnification for IMSI; x6000 - x70001,2,3 • Use of oil and DIC microscope not optimal for clinical practice – Alternative oil free digital system developed to improve IMSI efficiency without compromising performance & results 1 Souza Setti, A et al. Reprod Biomed Online. 2010 Oct;21(4):450-5 2 Nadalini, M et al. Reprod Biomed Online. 2009;19 Suppl 3:45-55 3 Ai, L et al. Zhonghua Nan Ke Xue. 2010 Sep;16(9):826-9 Cambridge IVF Creating your future
  • 9. IMSI – The RI System Hardware MRMC 2011 IMSI Workstation Cambridge IVF Creating your future Digital Camera Objective
  • 10. MRMC 2011 Cambridge IVF Creating your future
  • 11. IMSI UK Update – Study #1 MRMC 2011 • Patient Group – – – – ICSI Failure (>3 cycles) Repeated miscarriage Teratozoospermia (<4% Normal Forms) Poor blastocyst development • RI IMSI system – Magnification x6300 (x60 air objective with digital zoom) • Methodology – All sperm selected and collected before oocyte injection commenced Cambridge IVF Creating your future
  • 12. Results MRMC 2011 Chau et al, Fertility 2011 Cambridge IVF Creating your future
  • 13. IMSI UK Update – Study #2 MRMC 2011 • Patient Group – Patients with more than 6 eggs had ICSI & IMSI • Sperm graded prior to injection; Grading Category Description Grade I No Vacuolation Grade II <2 Small Vacuoles Grade III >2 small or >=1 large Vaculoes Grade IV • RI IMSI system Large Vacuole and other head Vanderzwalmen et al, 2008 abnormalities – Magnification x6300 (x60 air objective with digital zoom) Cambridge IVF Creating your future
  • 14. Results MRMC 2011 Best et al, Fertility 2011 Grade Description I No Vacuolation II <2 Small Vacuoles III >2 small or >=1 large Vaculoes IV Large Vacuole and other head abnormalities (n=114) Cambridge IVF Creating your future (n=108)
  • 15. IMSI – Our Plans MRMC 2011 • Clinical IMSI to roll out in June 2011 • Partnership with Research Instruments – RI system has been demonstrated to be the most user friendly, cost and time effective system for clinical use – Randomised prospective treatment study to contribute to UK IMSI dataset – Prospective clinical study to assess the effect of sperm preparation technique – Further work on sperm quality (grade) and its correlation to rates of fertilisation, cleavage, embryo development & implantation Cambridge IVF Creating your future
  • 16. Optimising the IMSI procedure MRMC 2011 PVP MSOME Selection (5µl) PVP Injection (5µl) Oocyte Injection (5µl) • Use PVP to slow sperm and aid analysis and capture • Use of Micropipette to trap a single good prognosis sperm for detailed analysis prior to selection • Collect and store good prognosis sperm prior to loading oocytes into the injection dish Cambridge IVF Creating your future
  • 17. The Isolator Concept MRMC 2011 • Isolator units linked together with ‘pass through’ incubators linking units together • Workspace heated, gassed and humidified to user specification • Built in HEPA and carbon filtration system ‒ Effective against particulates and VOC’s • Gametes and embryos are never exposed to suboptimal conditions • Significant increase in clinical treatment results Cambridge IVF Creating your future
  • 18. Summary MRMC 2011 • MSOME is a valuable clinical tool in the assessment of male factor infertility • IMSI is an effective treatment option for patients following failed ICSI treatment • IMSI may confer some protection against miscarriage when compared to ICSI • IMSI may improve success in cases of unexplained infertility • Optimise IMSI technique to reduce gamete stress • Develop systems to maintain biological conditions Cambridge IVF Creating your future
  • 19. Thank you for your Attention Terima Kasih Cambridge IVF Creating your future