IMSI - Intra-cytoplasmic Morphologically Selected Sperm Injection - Stephen Harbottle imsi workshop...
-
Upload
ri-uk-ireland -
Category
Health & Medicine
-
view
498 -
download
0
description
Transcript of IMSI - Intra-cytoplasmic Morphologically Selected Sperm Injection - Stephen Harbottle imsi workshop...
Cambridge IVFCreating your future
MRMC 2011
IMSI Workshop; use of the RI System
Stephen J. HarbottleLead Clinical Embryologist
Cambridge IVFCreating your future
MRMC 2011
Introduction
• 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 IVFCreating your future
MRMC 2011
MSOME
• 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 IVFCreating your future
MRMC 2011
Defining the ‘Normal Sperm’
• 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 IVFCreating your future
MRMC 2011
Significance of Nuclear Normalcy
• Normalcy of the sperm NUCLEUS was found to be a significant factor in pregnancy occurrence by ICSI procedure
Bartoov , B et al. Fertility and Sterility. 2003 Dec;80(6)
IMSI ICSI
Pregnancy Rate (%) 50% 25%
Abortion Rate (%) 13% 33%
Cambridge IVFCreating your future
MRMC 2011
Examples of Vacuolation
Cambridge IVFCreating your future
MRMC 2011Grade Description
I No Vacuolation
II <2 Small Vacuoles
III>2 small or >=1 large
Vaculoes
IVLarge Vacuole and
other head abnormalities
Vanderzwalmen et al, 17(5): 617-627, 2008
Cambridge IVFCreating your future
MRMC 2011
IMSI - Technical Development
• 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 IVFCreating your future
MRMC 2011
IMSI – The RI System Hardware
IMSI Workstation Digital Camera Objective
Cambridge IVFCreating your future
MRMC 2011
Cambridge IVFCreating your future
MRMC 2011
IMSI UK Update – Study #1
• 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 IVFCreating your future
MRMC 2011
Results
Chau et al, Fertility 2011
Cambridge IVFCreating your future
MRMC 2011
IMSI UK Update – Study #2
• Patient Group– Patients with more than 6 eggs had ICSI & IMSI
• Sperm graded prior to injection;
• RI IMSI system– Magnification x6300 (x60 air objective with digital zoom)
Grading Category Description
Grade I No Vacuolation
Grade II <2 Small Vacuoles
Grade III >2 small or >=1 large Vaculoes
Grade IV Large Vacuole and other head abnormalitiesVanderzwalmen et al, 2008
Cambridge IVFCreating your future
MRMC 2011
Results
Best et al, Fertility 2011
(n=114) (n=108)
Grade Description
I No Vacuolation
II <2 Small Vacuoles
III>2 small or >=1 large
Vaculoes
IVLarge Vacuole and other
head abnormalities
Cambridge IVFCreating your future
MRMC 2011
IMSI – Our Plans
• 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 IVFCreating your future
MRMC 2011
Optimising the IMSI procedure
• Use PVP to slow sperm and aid analysis and capture
PVP MSOME Selection (5µl)
PVP Injection (5µl)
Oocyte Injection (5µl)
• 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 IVFCreating your future
MRMC 2011
The Isolator ConceptThe Isolator Concept
• 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 IVFCreating your future
MRMC 2011
Summary
• 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 IVFCreating your future
Thank you for your Attention
Terima Kasih