If you decide to have IVF or ICSI treatment, you will first have the standard treatment. However, if several attempts are unsuccessful, the treatment can be extended to include various tests. Many of these extended options are ethically very complicated, especially if they involve genetic modification or sex selection. As a result, these tests usually involve a longer stay abroad during treatment and therefore high costs. However, there are also more advanced options that you can have done in your local clinic because they are less ethically questionable. Today we are going to talk about IMSI, which is also a method.

What is meant by abnormal sperm morphology?

Sperm always have a head and a tail, which makes them look like tadpoles. The important genetic information is stored in the head as a set of chromosomes. The tail is mobile and is mainly used for locomotion. So only the head is important for actual fertilisation and reproduction. This appearance of the cells is called morphology. By looking at the sperm under a microscope, the appearance can be further examined.

It is currently believed that a healthy sperm has a normal morphology. Conversely, this means that sperm with a normal morphology also have an intact genome. If the genetic material in the germ cells, i.e. egg or sperm, is already defective, there is a very high chance that the child will also be affected. The defective genetic material often prevents the embryo from developing properly. In many cases, the embryo is not even able to implant in the womb lining. Even if implantation goes well, the mother's body usually notices that something is not going to plan as the pregnancy progresses. It often reacts by rejecting the embryo and a miscarriage occurs.

Numerous studies have shown that 90% of all sperm cells have changes. These are called vacuoles. These are inclusions that are mainly found in the area of the sperm head. How these vacuoles develop and whether they actually affect the functionality of the affected sperm is unclear.

How does the treatment work?

IMSI is the process of selecting the sperm cells described above. IMSI stands for intracytoplasmic morphologically selected sperm injection. This unwieldy term means that sperm with conspicuous changes in the cytoplasm of the sperm head are sorted out before being added to the egg. IMSI can therefore be easily inserted between the collection of the individual gametes and the fertilisation in the laboratory.

The sperm are examined under a microscope. This is also done with the 'normal' method, but the resolution is much higher with the IMSI method. In standard IVF, the sperm are examined under a microscope at 400x magnification. This allows a rough assessment of the external shape, but gives little information about the structures inside the cells. IMSI uses a magnification of 6000. This allows the vacuoles to be seen very well. However, such a high magnification cannot be achieved with a conventional light microscope. As a result, clinics have to buy new equipment. As this is very expensive, many use a computer program that upscales the light microscope images to a higher resolution. This is much cheaper for the clinics, but the results are less accurate.

As far as treatment is concerned, nothing will change for you as a patient. The woman will receive hormone therapy and, if you have chosen IVF, eggs will be retrieved by puncture. With ICSI, no eggs are retrieved, but the treatment does not change because of the IMSI. The partner provides sperm as usual. They are then examined in the laboratory and the healthy cells are selected. Only these cells are then used in the egg.

Why does it work for so many despite the vacuoles?

You may be wondering why so many couples are able to have children if 90% of the sperm tested is found to have such inclusions. There are several possible explanations. On the one hand, it is not yet clear whether the vacuoles damage the sperm at all, or whether they may be completely irrelevant for fertilisation.

On the other hand, it is argued that in natural fertilisation, only the best sperm can automatically win. Natural selection therefore makes it possible that although there are many defective sperm, they are almost always at a disadvantage compared to the healthy cells and therefore do not even make it to the egg.

So far, IMSI has not made a significant difference to conventional IVF or ICSI. So many people tend to use the first argument.

Where can I get treatment?

As ISMI is only an optimisation of artificial insemination without a major ethical conflict, it is offered in most clinics in Germany, Austria and Switzerland. It is best to ask your fertility clinic if they offer it. If you don't have a clinic, your gynaecologist may be able to help you.

What does the treatment cost?

As IMSI is an additional treatment, it is usually not covered by health insurance. The cost of the IMSI alone is between 500 and 1000 euros, depending on the clinic. Most clinics only use the computer programme for cost reasons, which of course makes the treatment cheaper for you. However, you usually don't have a choice between the software and the microscope within a clinic, as they will use one or the other.

Ultimately, IMSI is like many treatments in this field. You are trying to solve an unclear problem without knowing for sure whether the treatment will actually work. While this treatment may be a waste of money for some couples, it may actually help patients with a known sperm production disorder. However, it is best to seek advice about your individual situation from the clinic of your choice.