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L’utilisation du MSOME: expérience de six ans

IMSI: six years of practice

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Résumé

Introduction

L’analyse fine de la morphologie des spermatozoïdes à un grossissement de 6600 x, appelée MSOME (motile sperm organellar morphology examination) et appliquée en ICSI, a donné naissance à l’IMSI (intracytoplasmic morphologically selected sperm injection). Cette technique est proposée aux couples en échecs répétés d’implantation embryonnaire en ICSI, dans le but d’obtenir une grossesse évolutive.

Matériel et méthodes

L’étude concerne une cohorte observationnelle de 11535 ICSI pratiquées avec du sperme éjaculé frais, de janvier 2004 à juillet 2009. Parmi celles-ci, 2509 ont été réalisées avec IMSI. Les paramètres étudiés sont: le taux de clivage à J2 par ovocyte injecté, le taux de grossesses cliniques par ponction et le taux de fausses couches spontanées, en fonction du rang de la tentative et/ou de la qualité du sperme du bilan. Ces données ont été comparées entre l’ICSI et l’IMSI et les comparaisons ont été faites à l’aide de Chi2 et d’analyse de variance.

Résultats

Nous n’avons pas observé de différence significative entre l’ICSI et l’IMSI en termes de taux de clivage à J2 et taux de grossesses cliniques. Par contre, le taux de grossesses, en IMSI de rang 1, est significativement plus élevé en cas d’anomalie du sperme si on regroupe les tératozoospermies avec les oligozoospermies et les oligotératozoospermies (34,4 vs 27,1%, p = 0,02). De plus, si l’on regroupe les tératozoospermies et les oligotératozoospermies, le taux de fausses couches est plus faible en IMSI comparé à l’ICSI, de manière proche de la significativité (12,6% vs. 19,6%, p = 0,08).

Conclusion

En présence d’une tératozoospermie sévère, l’IMSI semble augmenter les taux de grossesses et diminuer les taux de fausses couches.

Abstract

Introduction

MSOME (Motile Sperm Organellar Morphology Examination) is a new method for real-time evaluation of sperm morphology under 6600x high magnification. ICSI modified procedure with sperm selected by MSOME is named IMSI (Intracytoplasmic Morphologically Selected sperm Injection). IMSI has been developed to improve ongoing pregnancy rate in couples with repeated implantation failure.

Material and methods

The study concern an observational cohort of 11535 ICSI performed with fresh ejaculated sperm in our ART lab between January 2004 and July 2009. Among them, 2509 were realized with IMSI. The primary outcome measures were cleavage rate per injected oocyte on day 2, clinical pregnancy and abortion rates. Comparisons were performed using Chi square2 test and univariate analysis of variance.

Results

There were no significant difference between conventional ICSI and IMSI groups in term of cleavage and pregnancy rates. Couples with abnormal sperm (teratozoospermia, oligozoospermia and oligoteratozoospermia) and no previous ICSI failure, had a significantly higher clinical pregnancy with IMSI than with ICSI (34.4% vs. 27.1%, p = 0.02). Furthermore, pregnancies obtained in patients with teratozoospermia were associated with a lower abortion rate after IMSI than after ICSI, close to significance (12.6% vs. 19.6%, p = 0.08).

Conclusion

In cases of severe teratozoospermia, IMSI appears to improve pregnancy rate and pregnancy outcome.

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Correspondence to M. Dumont.

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Dumont, M., Junca, A.-., Belloc, S. et al. L’utilisation du MSOME: expérience de six ans. Basic Clin. Androl. 21, 83–89 (2011) doi:10.1007/s12610-011-0122-7

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Mots clés

  • MSOME
  • IMSI
  • Sélection
  • Spermatozoïdes
  • Grossesses

Keywords

  • MSOME
  • IMSI
  • Selection
  • Sperm
  • Pregnancies