IMSI IVF Cycle – Will it improve YOUR chance of pregnancy?
When we were going through our IVF cycles, we knew that due to my non consistent quality of sperm that we may need ICSI as part of our treatment.
Obviously if this was the case, I wanted to be sure that we gave ourselves the best opportunity for a successful IVF cycle.
One of the technologies that I spent hours researching was IMSI, what I found written by clinics vs what was evidenced surprised me. Below is a summary of what I found on my adventures into IMSI IVF.
What is IMSI IVF Cycle and how does it differ from ICSI
IMSI stands for Intracytoplasmic morphologic sperm injection, which is a bit of a mouthful. Try saying it 3 times quickly.
You couldn’t could you.
Anyway, moving forwards we’ll refer to it as IMSI. It is a technology based on ICSI (i.e. they inject the sperm directly into the egg) which you can read more about in our guide to ICSI. In 2001 a new method based on motile sperm organelle morphology examination more commonly known as MSOME was developed.
This is a technique where they use ultra-high magnification in the realm of 6000x -6600x as apposed to ICSI which is between 200-400x. Using this high magnification, they are able to look in detail at the morphology (shape of the sperm). This is especially useful for looking for defects in the head which wouldn’t be able to be identified under the lower magnification.
Other than the sperm selection, the process is for both the injection treatment and the rest of IVF is the same.
What clinics can say vs what the evidence says for IMSI IVF cycles
These are some statements taken straight from IVF clinics
“Published studies on the use of IMSI have found that couples who underwent IMSI had higher pregnancy and birth rates and lower miscarriage rates”
“IMSI takes ICSI to the next level”
“With IMSI the magnification is up to 6000 times, which enables the embryologists to see more accurately abnormalities in the head of the sperm. By selecting sperm without abnormalities, the chance of creating better quality embryos is higher.”
“This efficient collection of sperm without morphological changes is regarded to improve the odds of effective implantation of the pre-embryo and also reduce the chance of miscarriage”
“Cases where IMSI may be recommended
- A high number of abnormal sperm are found in a semen analysis
- Repeated unsuccessful IVF cycles
- History of recurrent miscarriages
- No good quality embryos formed in previous cycles”
These sorts of claims can encourage couples to take up these treatments, but what does the evidence state about IMSI?
I looked at a number of trials, literature reviews and peer-reviewed articles to get an overall feel for the evidence base of IMSI.
I’ll start by saying the evidence for IMSI IVF cycles does not demonstrate that it should be offered to couples as it doesn’t ‘at this point’ show signs of improving live pregnancy rates.
Cochrane (the gold standard of literature research for healthcare) performed a literature review in 2013 (external link to research). It looked at research of 9 randomised controlled studies which included 2,014 couples. These studies compared regular ICSI with IMSI IVF Cycles.
These studies were predominantly funded by universities and fertility clinics. The key outcome of the study was that there was low evidence of any benefit or any harm to come from IMSI.
The range of data from these studies, showed that for an average live birth rate of 38% when using regular ICSI. Those on IMSI had a variation of success rates from 30-63%.
For those that had al pregnancy rate of 33% with ICSI, IMSI had between 36% and 52%.
They sound great right! Till you read this bit:
“…the quality of this evidence was downgraded because of imprecision, inconsistency of the observed effect across studies, and high risk of publication bias”
So, in simple terms, they found that the design of the study had a bias, which is very common in commercial organisations research which is trying to sell a product. Further to that there was inconsistent and imprecise data. As such the data is non-reliable.
The final conclusion was that they don’t support the use of IMSI for any reason and that more research should be done.
A 2016 Article by, N. Gatimel, J. Parinaud, and R. D. Leandri which can be found here (external link to research) this is a non-randomised trial, which does have it’s downsides.
It explicitly looked at couples from a specific hospital who had 2 previous failed cycles (which is one of the reasons often stated by IVF clinics as to why you should get IMSI) over a 4-year period.
Its findings were:
“IMSI did not significantly improve the clinical outcomes compared with ICSI, either for implantation (12% vs 10 %), clinical pregnancy (23 vs 21 %), or live birth rates (20 vs 19 %).”
There is a lot of research on this specific IVF treatment add-on. With some seemingly positive results and the majority minor impacts or no impacts at all.
What you will notice if you start to look into the evidence base as we have, is that the positive research is almost exclusively from fertility clinics themselves, and thus the research teams have a potential conflict of interest, i.e. they run a private fertility practice, which offers this IVF treatment add-on.
Whilst, the majority of those with minor or no positive impacts were from universities or non-affiliated research groups. Whilst this is a generality and not the case for all the studies out there; there is certainly a pattern.
Are there any additional risks with IMSI IVF cycles?
IMSI has all the same risks as a normal ICSI IVF cycle, the non-invasive element of the procedure does not add any further specific risk to the sperm or embryo. However as with any ICSI procedure this bit is invasive and can lead to damage to the embryo. The biggest risk of IVF overall is OHSS (link to our article).
Should I get IMSI or just have regular ICSI.
From all the information that we have gathered through our research, speaking to fertility specialists and looking deep into the technology it is clear to us that IMSI currently doesn’t have enough evidence to recommend it as an IVF treatment add-on in any capacity.
This is further supported by the HFEA website rating this IVF treatment add-n as red, meaning it doesn’t recommend and more research needs to be done.
In our opinion there are much better IVF add-ons to spend your hard earned money on, which there is greater evidence of possible positive impacts.
This is especially true for people considering it as they already have the need to pay for ICSI which comes in at £897. To learn more about IVF costs check out our ultimate guide. IMSI isn’t listed as a cost on many clinics, however I got in touch with a number of clinics and the average appeared to be around an additional £350 for IMSI which doesn’t seem great value for money as it takes about 60 minutes of microscope work.