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Evaluation de l’apport de la méthode d’observation des spermatozoïdes à fort grossissement en ICSI

Evaluation of motile sperm organelle morphology examination in unselected in Vitro fertilization with intra-cytoplasmic sperm injection

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Nous avons souhaité évaluer l’intérêt de la sélection des spermatozoïdes par la méthode d’observation à fort grossissement, appelée MSOME (Motile Sperm Organelle Morphology Examination), par rapport à celle habituellement réalisée en ICSI. Notre objectif était de déterminer le pourcentage de spermatozoïdes sélectionnés en ICSI conventionnelle qui s’avéraient anormaux à fort grossissement, et d’évaluer la valeur prédictive de ce paramètre sur l’issue de la tentative d’ICSI.

L’étude a concerné 25 tentatives d’ICSI sans sélection d’indication. Pour chaque patient, 25 spermatozoïdes mobiles et “injectables” d’après l’évaluation morphologique conventionnelle en ICSI ont été observés en MSOME à un grossissement supérieur à ×4500 et classés selon une grille de lecture adaptée des travaux de Bartoov et de la classification de David modifiée. Nous avons comparé les résultats de MSOME et l’issue des ICSI correspondantes.

Dans cette courte série d’ICSI sans sélection d’indication, nous avons retrouvé des fréquences élevées d’anomalies (supérieures à 70%) et notamment de vacuoles nucléaires. Nous n’avons pas retrouvé de valeur prédictive de la morphologie spermatique évaluée à fort grossissement, y compris des vacuoles, pour le taux de fécondation, la qualité embryonnaire ou l’issue de l’ICSI. De plus, des grossesses ont été obtenues avec des spermes très altérés. Dans cette série, les vacuoles ne semblent pas avoir de signification péjorative pour l’obtention d’une grossesse.

Plusieurs questions sont soulevées à l’issue de ce travail : quel est le support et la signification des vacuoles observées en MSOME ? Y a-t-il une corrélation entre la morphologie spermatique et le contenu génétique ? Enfin, des études prospectives randomisées semblent nécessaires afin de valider les indications potentielles de cette technique.

Abstract

Due to the growing interest in the method of high-magnification sperm observation and selection proposed for the specific indication of ICSI failure, the authors evaluated the technique in unselected ICSI.

The aim of this study was to evaluate the relevance of Motile Sperm Organelle Morphology Examination (MSOME) compared with usual selection performed in ICSI. In a series of conventionally selected sperm for ICSI, the number with an abnormal appearance on high magnification was determined and the predictive value of this parameter on ICSI outcome was assessed.

The study included 25 successive unselected ICSI attempts in the IVF Laboratory of Poissy Hospital (France). ICSI were performed according to usual protocols used in the laboratory. Twenty five motile spermatozoa of the migrated fraction, still available after ICSI, and “injectable— according to conventional morphology assessment in ICSI (“normal” or “as normal as possible” with magnification of ×200–400) were assessed by MSOME (higher than ×4500) and classified according to criteria adapted from Bartoov’s work and taking into account David’s sperm morphology classification. We compared the results of MSOME and ICSI results.

In this small series of ICSI with diverse indications, we found very high frequencies of abnormalities (more than 70%), particularly nuclear vacuoles. No predictive value of the morphology of sperm assessed with high magnification (including vacuoles) was found for fertilization rate, embryo quality and ICSI outcome. In contrast with previous reports, pregnancies were obtained with very abnormal sperms. In this series of unselected ICSI, nuclear vacuoles do not seem to have a pejorative impact on pregnancy outcome.

This study raises several perspectives. It would be interesting to understand the “anatomical” basis for vacuoles observed with MSOME and their meaning. The question of the phenotype-genotype relation, i.e. the possible correlation between sperm morphology and genetic content could be investigated. Finally, a prospective analysis should be performed in clearly defined indications to validate the potential applications of the method for high-magnification sperm observation and selection.

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Author information

Correspondence to Nathalie Sermondade or François Vialard or Marianne Bergere or Ibrahim Hammoud or Patrick Cavelot or Jacqueline Selva or Martine Albert.

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Sermondade, N., Vialard, F., Bergere, M. et al. Evaluation de l’apport de la méthode d’observation des spermatozoïdes à fort grossissement en ICSI. Androl. 17, 212–222 (2007) doi:10.1007/BF03040730

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Mots clés

  • morphologie spermatique
  • observation et sélection des spermatozoïdes à fort grossissement
  • ICSI
  • MSOME
  • IMSI
  • vacuoles nucléaires

Key-words

  • sperm morphology
  • high-magnification sperm
  • observation and selection
  • MSOME
  • ICSI
  • IMSI
  • nuclear
  • vacuoles