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Intracytoplasmic morphologic sperm injection (IMSI)

Treatment add-on

IMSI is rated red

IMSI is rated red

Red

What does this traffic light rating mean?

The traffic light rating system consists of three colours that indicate whether the evidence, in the form of high-quality randomised control trials (RCTs), shows that a treatment add-on can safely improve the live birth rate for someone undergoing fertility treatment.

We give a red symbol for an add-on where there is no evidence to show that it can improve live birth rates. We also give a red symbol for an add-on where there is evidence to show that the add-on is unsafe.

The January 2019 consensus statement between the HFEA and 10 other professional and patient bodies agreed that treatments that have no robust evidence of their safety and/or effectiveness should only be offered in a research setting. Patients should not be charged extra to take part in research, including clinical trials, and should not be charged to use red-rated treatment add-ons if the reason for its use is to improve live birth rates.

For specific patient groups there may be reasons for the use of a treatment add-on other than to increase live birth rate, for example to reduce your chances of having a miscarriage. In these situations it may be appropriate for you to be offered a treatment add-on as part of your treatment and not in a research setting.

What is IMSI?

Intracytoplasmic morphologically selected sperm injection (IMSI) is a sperm selection method used in intracytoplasmic sperm injection (ICSI). The technique involves using a microscope to view sperm under very high magnification (over x6000). This allows clinics to view detailed images of sperm.

Are there any risks?

IMSI is a non-invasive test performed on a semen sample as an additional step in the ICSI process. The risks associated with the use of ICSI also apply to IMSI; there are no significant additional risks to the patient or embryo.

Find out more about ICSI

What’s the evidence for IMSI?

At the October 2019 Scientific and Clinical Advances Advisory Committee (SCAAC) meeting the Committee evaluated the evidence base for IMSI. Minutes of this discussion and the evidence used to inform this discussion is available here.

There have been several RCTs within the last decade. Systematic reviews suggest that IMSI could be beneficial in specific situations such as previously failed ICSI attempts. The research that has been carried out does not support the use of IMSI over standard ICSI. One small study found that IMSI had improved pregnancy outcomes in older patients, however this study was carried out with a small number of participants and the link, if any, between IMSI and older eggs is not fully understood.

What are treatment add-ons?

Treatment add-ons are optional additional treatments that you may be offered on top of your routine fertility treatment, often at an additional cost. Some clinics may refer to treatments add-ons as ‘supplementary’ or ‘embryology treatments’. There are a wide range of treatment add-ons on offer including tests, drugs, equipment, holistic or alternative therapies, and surgical interventions.

However, all treatment add-ons share one common characteristic: they claim to improve the chances of having a baby (live birth rate). Evidence on whether some treatment add-ons are safe or effective is often missing or absent. These claims can attract a lot of attention with many patients opting for a treatment add-on thinking that it may be the best option for them despite there being little or no evidence to prove it is.

Treatment add-ons have varying levels of scientific evidence to support their effectiveness and safety and, at times, this evidence can be contradictory. It is important to keep in mind that for most patients, routine fertility treatment is an effective option on its own.

We aim to publish clear and reliable information about some of the treatment add-ons that lack sufficient evidence to show that they are effective and/or safe. This allows patients to make an informed decision about whether using a treatment add-on as part of their treatment is the best option for them.

To make it easier to understand the scientific evidence for each treatment add-on we have developed the HFEA’s traffic-light rated list of add-ons.

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Review date: 25 August 2022

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