How IVF IMSI, MACS, PICSI or other procedures can help with male factor problem

There are many success factors to IVF. Most crucial is to determine the causes. Although every case is different and requires a different approach, there are well- established procedures in use. When male factor comes into play, sperm selection techniques chosen for a specific purpose help improve the results.

Multiple studies show that sperm quality has a direct impact on embryo development, so sperm selection is extremely important. The most common techniques used for sperm selection are: IMSI – Intracytoplasmic morphologically selected sperm injection, PICSI – Physiological Intracytoplasmic sperm injection, MACS – Magnetic activated cell sorting, HOS – Hypo-osmotic swelling test, Fertile microfluidic sperm sorting chips.

To know more about each of these approaches watch the series of 3 videos from our experts:
• Dr Ruth Sanchez, Reproduction Unit of Clinic Vistahermosa
• Dr Aldo Isaac Meneses Rios, UR Ciudad de Mexico
• Dr Evi Tymotheou, Assisting Nature

Is there anything we can do about the male factor using IVF lab techniques: IMSI, MACS, PICSI and others?

3on1 #IVFANSWERS: one question, three experts. New #IVFANSWER every week.
Please find 3 answers recorded with 3 IVF experts below.

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Answer from Dr Sanchez

IMSI basically consists in making a preliminary selection of the sperm through a microscope 15 times more powerful than those that are usually used to perform ICSI. Although this improvement in sperm selection could make us think about an increase in pregnancy and implantation rates and a decrease in the rate of abortions, the reality is different. There are studies that have showed the ineffectiveness of this technique in the selection to improve pregnancy rates. Besides, it is a very expensive method that requires too much time in searching for sperm, which has a negative effect on the oocyte to microinject. Currently, IMSI is a technique that needs well-designed studies to show us with sufficient scientific evidence if it really works for a certain group of patients. For now, it’s validity is limited to the commercial marketing of the centre that offers it.

PICSI is another technique that involves placing the sperm on an ICSI plate, treating it with a synthetic material similar to the characteristics of the zona pellucida of the oocyte so that mature sperm that isn’t so damaged in terms of DNA will remain attached to this synthetic material. Subsequently, the sperm is recovered to be used for microinjection, which is an old method easily performed with the current technique of straining through Annexin columns that select non-apotopic sperm without going through these methods.

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Dr Aldo Isaac Meneses Rios,
UR Ciudad de Mexico, Mexico

Answer from Dr Rios

IMSI basically consists in making a preliminary selection of the sperm through a microscope 15 times more powerful than those that are usually used to perform ICSI. Although this improvement in sperm selection could make us think about an increase in pregnancy and implantation rates and a decrease in the rate of abortions, the reality is different. There are studies that have showed the ineffectiveness of this technique in the selection to improve pregnancy rates. Besides, it is a very expensive method that requires too much time in searching for sperm, which has a negative effect on the oocyte to microinject. Currently, IMSI is a technique that needs well-designed studies to show us with sufficient scientific evidence if it really works for a certain group of patients. For now, it’s validity is limited to the commercial marketing of the centre that offers it.

PICSI is another technique that involves placing the sperm on an ICSI plate, treating it with a synthetic material similar to the characteristics of the pellucid zone of the oocyte so that mature sperm that isn’t so damaged in terms of DNA will remain attached to this synthetic material. Subsequently, the sperm is recovered to be used for microinjection, which is an old method easily performed with the current technique of straining through Annexin columns that select non-apotopic sperm without going through these methods.

It’s important to say that the Annexin selection is cheaper than PICSI and the rate of pregnancy success is similar.

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Evi Tymotheou,
Assisting Nature, Greece

Answer from Evi Tymotheou

Sperm selection prior to fertilisation is a crucial step for IVF success. When the male factor is present, among other fertility causes, selecting the best and most prominent sperm can be challenging. Such cases require a different approach. As a result, there are several techniques utilised and each of them has a purpose. To select the optimal sperm, the most common techniques used for this purpose are:

  • Intracytoplasmic morphologically selected sperm injection called IMSI
  • Physiological Intracytoplasmic sperm injection called PICSI
  • Magnetic activation cell sorting called MACS
  • Hypo-osmotic swelling test called HOS
  • Fertile microfluidic sperm sorting chips

Apart from these techniques there are others that are not used so often. A method that allows the intracytoplasmic injection of morphologically selected sperm is called IMSI. The sperm image is maximised up to 6,600 times, allowing the embryologist to choose only the ones that are the healthiest and have the best morphology. Finding from IMSI imaging helps to discard spermatozoa with mitochondrial disfunction or DNA damage and helps to identify spermatozoa with a normal nucleus and nuclear content.

IMSI can contribute to improving the success rates of patients who appear to have bad sperm morphology and have been diagnosed with Oligo-asthenoteratozoospermia. According to studies, it has been shown that this particular method can lead to better fertilisation rates, better embryo quality and, as a consequence, better pregnancy rates. In addition, IMSI is a useful technique for couples with unexplained infertility or couples with repeated implantation failures.

Another method is PICSI. PICSI offers a new assessment criteria for sperm selection as it is based on the ability of the sperm to bind to the hyaluronic acid. Specifically, in this method special dishes are used which contain special culture media with hyaluronic acid. When the sperm sample is added to the dish, only the spermatozoa with the best quality can bind to the acid and, as a consequence, are sorted by the embryologist for the micro-fertilisation. The principle of the method is based on the fact that hyaluronic acid naturally occurs in the substance that surrounds the oocyte and plays a critical role in the sperm-oocyte fusion. Therefore, spermatozoa which appear to have the ability to bind with the hyaluronic acid are supposed to be mature and have less chromosomal abnormalities. This method is useful in cases of failure or low success rates after previous acceptance, in couples with low embryo quality, repeated implantation failures, with embryos that do not develop sufficiently as well as those who come forward regarding miscarriages or when the man is diagnosed with sub-fertility and a high rate of sperm DNA fragmentation.

Another technique that we used is the MACS technique. This method is based on the use of magnetic nanoparticles which have surface-specific antibodies to recognize and adhere to the apoptotic spermatozoa. The sample then passes through a magnetic filter that binds the apoptotic sperm while allowing the normal one to pass. This method is useful in cases of couples with poor embryo quality as well as couples that come forward regarding miscarriages or when the man is diagnosed with sub-fertility and a high rate of sperm DNA fragmentation.

HOS is a method to estimate chromatin integrity based on the degree of swelling of the cytoplasm and curling of the tail in live sperm when exposed to hypo-osmotic conditions. The assay is based on the fact that fluid transport occurs across an intact cell membrane under hypo-osmotic conditions until an equilibrium is reached. Due to the influx of the fluid, the cell will expand and bulge—especially the tail—and this change can be really observed with a phase contrast microscope. This method is highly indicated for couples with total immotile sperm.

The last method that we use is the fertile chip, which is a flow for a single use device with 5 lanes. It consists of an inlet port connected to a larger outlet collection port by a micro-fluid channel. The limited depth of the channel constrains the migration of compromised sperm while allowing the most motile, healthy sperm to migrate to the outlet where they are ready for harvest. FERTILE slides can help eliminate the damaging procedures correlated with sperm washing and gradient centrifugation. In addition, the sperm sorted by fertile chip exhibits better morphology, lower levels of reactive oxygen species and less DNA fragmentation than the original semen sample. So, as a conclusion we have to keep in mind that male factor fertility may be one or a combination of low sperm concentration, poor sperm motility or abnormal morphology. Using the methods mentioned before, we can improve the fertilisation rate after ICSI, the embryo quality, the blastulation, implantation and pregnancy rate. But our purpose, of course, using all these techniques—other than just the rates—is to help you take home a healthy baby.

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About the Author

Dorothy Walas

Dorothy Walas

Dorothy has solid background in communication, social media, and content creation. She is always on the lookout for news in the IVF industry and is in touch with IVF organisations, writers, bloggers and clinics. Dorothy believes in transparency of the message sent to patients and easy access to IVF knowledge. She manages the website and social media content to educate patients, spread awareness about egg donation, bust the IVF myths and assist patients in making decisions that are right for them, not for the clinic. Dorothy’s personal interests are strongly linked to her work; she is interested in biology, genetics and is an advocate of healthy and active living.

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