***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In previous studies , a new IVF method of intracytoplasmic morphologically selected sperm injection ( IMSI ) was introduced , based on motile sperm organellar morphology examination ( MSOME ) . It was concluded that microinjection of morphologically selected sperm cells with strictly normal nucleus , defined by MSOME , improves IVF-ICSI outcome . The aim of the present study was to confirm this conclusion in new , enlarged study groups . Comparison between 80 couples , who underwent an IVF-IMSI trial , with matched couples , who underwent a st and ard IVF-ICSI procedure , confirmed that pregnancy rate following IVF-IMSI was significantly higher , and abortion rate significantly lower than in the routine IVF-ICSI ( 60.0 versus 25.0 % , and 14 versus 40 % respectively , P < or= 0.05 ) . Another comparison was performed between matched IMSI groups , where embryos were obtained from microinjection by spermatozoa with a morphologically normal nucleus ( ' best ' group , n = 70 ) and a ' second best ' group was selected , where embryos were obtained from microinjection of spermatozoa with minimal morphological impairment , since no other sperm cells were available . It was confirmed that microinjection by ' second best ' spermatozoa result in significantly lower pregnancy and delivery rates and significantly higher abortion rates than microinjection with ' best ' spermatozoa ( 25.7 versus 58.2 % , P < or= 0.01 ; 17.1 versus 52.8 % , P < or= 0.01 , and 33.3 versus 9.7 % , P < or= 0.02 respectively ) . The present study has strengthened previous conclusions OBJECTIVE To determine the effect of using MACS technology on clinical pregnancy , as a method for separation of damaged sperm in infertile patients . METHODS 136 infertile men having normal semen parameters in accordance with WHO 2010 criterion , undergoing ICSI cycle were enrolled during the course of the study . The patients were prospect ively r and omized and enrolled after oocyte retrieval and were assigned to the ICSI group , PICSI group or MACS group . Embryo development and clinical pregnancy were assessed . In 17 r and omized MACS patients , sperm DNA fragmentation was tested in the presumptive apoptotic and no apoptotic spermatozoa fractions . RESULTS Similar results were obtained between groups for the following parameters : fertilization rates of 78.97 % ( 95 % confidence interval [CI]:74.37 - 83.57 ) , 70.15 % ( 95 % CI:63.98 - 76.33 ) and 80.28%(95 % CI:73.74 - 86.81 ) for ICSI , PICSI and MACS group , respectively ; Number of Day-3 embryos was 5.04 ( 95 % CI:4.09 - 5.98 ) , 5.17(95 % CI:4.24 - 6.10 ) and 5.59(95 % CI:4.31 - 6.87 ) for ICSI , PICSI and MACS group , respectively ; number of freezing embryos in blastocyst stage was 0.78 ( 95 % CI:0.25- 1.31 ) , 0.70(95 % CI:0.27 - 1.14 ) and 1 ( 95 % CI:0.37 - 1.6 ) for ICSI , PICSI and MACS group , respectively . However , clinical pregnancy rates of 58.1 % for MACS group versus 40.4 % and 27.3 % for PICSI and ICSI group , respectively , were showed statistical difference ( P=0.019 ) . DNA fragmentation index for the two sperm MACS fraction showed statistical differences ( P=0.000 ) , MACS reduced the D.F.I of the sperm sample . CONCLUSIONS The use of MACS technology improves the clinical pregnancy on infertile couples and can be applied as a method for sperm separation , discriminating sperm with high DNA fragmentation OBJECTIVE To examine the effect of sperm morphology on embryo development at the chromosomal level . DESIGN Prospect i ve study . SETTING Assisted fertilization center . PATIENT(S ) Couples who underwent IVF-PGS cycle , as a result of advanced maternal age , were r and omly allocated into two groups : intracytoplasmic sperm injection ( ICSI ; n = 60 ) or intracytoplasmic morphologically selected sperm injection ( IMSI ; n = 60 ) . INTERVENTION(S ) IVF in conjunction with preimplantation genetic screening ( PGS ) . MAIN OUTCOME MEASURE(S ) Sperm nuclear morphology at high-magnification  ICSI and incidence of aneuploidy in derived embryo . RESULT ( S ) There was a significantly increased incidence for sex chromosome aneuploidy in ICSI embryos when compared with IMSI embryos ( 23.5 % vs. 15.0 % , respectively ) . High-magnification sperm selection was associated with a significantly lower risk of sex chromosome abnormalities ( odds ratio [ OR ] , 0.57 ; confidence interval [ CI ] , 0.37 - 0.90 ) . The incidence of chaotic embryos was also significantly higher with the ICSI procedure ( 27.5 % vs. 18.8 % ) , while the IMSI procedure was associated with a significantly lower risk of chaotic embryos ( OR , 0.64 ; CI , 0.43 - 0.96 ) . Moreover , the cycle cancellation rate was significantly higher in ICSI cycles ( 11.8 % vs. 2.5 % ) . High-magnification sperm selection was a significant predictor of the likelihood of cycle cancellation ( OR , 0.26 ; CI , 0.11 - 0.62 ) . CONCLUSION ( S ) Spermatozoa free of nuclear morphological malformations were found to be significantly associated with the lower incidence of aneuploidy in derived embryos , result ing in lower rates of cycle cancellation OBJECTIVE To verify whether microinjection into retrieved oocytes of motile spermatozoa with morphologically normal nuclei , strictly defined by high power light microscopy ( x > 6000 ) , improves the IVF/intracytoplasmic sperm injection ( ICSI ) pregnancy rate in couples with repeated ICSI failures . DESIGN Comparative prospect i ve study testing routine IVF/ICSI outcome parameters against those of modified ICSI based on morphological selection of spermatozoa with normal nuclei . SETTING Male factor fertility laboratory and IVF center . PATIENT(S ) Sixty-two couples , with at least two previous consequent pregnancy failed ICSI cycles , underwent a single ICSI trial preceded by morphological selection of spermatozoa with normal nuclei . Fifty of these couples were matched with couples who underwent a routine ICSI procedure at the same IVF center and exhibited the same number of previous ICSI failures . INTERVENTION(S ) St and ard ICSI and modified ICSI . MAIN OUTCOME MEASURE(S ) ICSI pregnancy rate . RESULT ( S ) The matching study revealed that pregnancy rate after modified ICSI was significantly higher than that of the routine ICSI procedure ( 66.0 % vs. 30.0 % ) . CONCLUSION ( S ) Microinjection into retrieved oocytes of selected spermatozoa with strictly defined morphologically normal nuclei improves significantly the incidence of pregnancy in couples with previous ICSI failures The capability of human zona pellucida ( ZP ) to bind selectively to normal functional sperm with normal chromatin has been reported widely in the literature . The aim of this study was to evaluate whether ZP-binding sperm selection may represent a method to retrieve superior spermatozoa for intracytoplasmic sperm injection ( ICSI ) . Patients were divided into two groups : a ZP-ICSI and a conventional ICSI group . In the ZP-ICSI group , spermatozoa for injection were selected after ZP-sperm incubation and spermatozoa that were tightly bound to the ZP were used for ICSI ( ZP-ICSI ) . Clinical outcomes of ZP-ICSI were compared with the outcomes of traditional scientist-selected sperm injection ( conventional ICSI ) . Results did not show any significant difference in fertilization , pregnancy , implantation and take-home-baby rates between conventional ICSI and ZP-ICSI . However , when data relative to patients who received ZP-ICSI were analyzed , an interesting result was observed : higher sperm concentration and morphology correlated with higher ZP-sperm binding . Additionally , patients with higher ZP-sperm binding seem to have improved pregnancy and take-home-baby rates . In conclusion , this study shows that ZP-ICSI is not a superior method compared with conventional ICSI . However , clinical ICSI outcomes were apparently improved in the presence of good ZP-sperm binding . We therefore speculate that sperm competence to ICSI could be reduced when the sperm 's ability to bind the ZP is impaired The aim of this study was to compare assessment of sperm morphology by using David 's classification ( DC ) , a method of manual analysis most common in France , with a computer-assisted method ( Integrated Visual Optical System ) based on the strict criteria ( CASA SC ) for their ability to predict fertilization in a selected in vitro fertilization ( IVF ) population . A total of 120 couples engaged in IVF protocol s were prospect ively included in the study . To focus mainly on sperm morphology , couples were excluded in cases of abnormalities of sperm concentration and /or motility and immunological factors and when a low number of oocytes were collected .  Sperm morphology analysis was performed on the day of oocyte retrieval by the same trained biologist . Our results showed a moderate correlation between the two techniques ( r = 0.49 ) . The DC sperm morphology analysis was less indicative of fertilization than CASA SC ( r = 0.07 , p = 0.47 vs. r = 0.22 , p = 0.014 ) . Using receiver-operating characteristics analysis , we showed that DC was not discriminating in the prediction of fertilization ( AUC = 0.572 ) . DC seemed less appropriate for the prediction of fertilization success or failure . In contrast , with CASA SC , the previously determined cut-off value of around 14 % was confirmed ( AUC = 0.735 , cut-off = 6 % ) . Our results argue in favour of the replacement of DC by SC to tend towards worldwide st and ardization This prospect i ve r and omized study investigated whether intracytoplasmic sperm injection ( ICSI ) outcome can be improved with sperm pre selection under ×6000 magnification and intracytoplasmic morphologically selected sperm injection ( IMSI ) in patients with teratozoospermia and characterized embryo development and quality regarding sperm morphology and presence of head vacuoles . Couples with isolated teratozoospermia were divided into two groups : IMSI group ( n=52 ) and ICSI group ( n=70 ) and fertilization , blastocyst and clinical pregnancy rates were compared . Oocytes from 30 r and omly chosen patients from the IMSI group were injected with spermatozoa that had been previously classified under ×6000 magnification into four classes according to the number and size of vacuoles in the head and then cultured separately . Pronuclear morphology , embryo development and blastomere viability were estimated to investigate the influence of sperm morphology , especially vacuoles , on embryo developmental capacity . A significantly higher clinical pregnancy rate was achieved in the IMSI group compared with the ICSI group ( 48 % versus 24 % , P<0.05 ) . Fertilization with spermatozoa without head vacuoles yielded higher number of morphologically normal zygotes , higher blastocyst rate and smaller proportion of arrested embryos than spermatozoa with vacuoles and other head defects . IMSI is a method of choice in patients with teratozoospermia Background Sperm of poor quality can negatively affect embryo development to the blastocyst stage . The aim of this comparative prospect i ve r and omized study was to evaluate the role of an intracytoplasmic morphologically selected sperm injection ( IMSI ) in the same infertile couples included in the programme of intracytoplasmic sperm injection ( ICSI ) due to their indications of male infertility which had result ed in all arrested embryos following a prolonged 5-day culture in previous ICSI cycles . Methods Couples exhibiting poor semen quality and with all arrested embryos following a prolonged 5-day culture in previous ICSI cycles were divided into two groups : Group 1 : IMSI group ( n = 20 ) with IMSI performed in a current attempt and Group 2 : ICSI group ( n = 37 ) with a conventional ICSI procedure performed in a current attempt of in vitro fertilization . Fertilization rate , embryo development , implantation , pregnancy and abortion rates were compared between current IMSI and conventional ICSI procedures , and with previous ICSI attempts . Results The IMSI group was characterized by a higher number of blastocysts per cycle than the ICSI group ( 0.80 vs. 0.65 ) after a prolonged 5-day embryo culture . There was a significantly lower number of cycles with all arrested embryos and cycles with no embryo transfer in the IMSI group versus the ICSI group ( 0 % vs. 27.0 % , p = 0.048 ) . After the transfer of embryos at the blastocyst or morula stage ( on luteal day 5 ) a tendency toward higher implantation and pregnancy rates per cycle was achieved in the IMSI group compared to the ICSI group ( 17.1 % vs. 6.8 % ; 25.0 % vs. 8.1 % , respectively ) , although not statistically 
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Evidence was also insufficient to show whether there is a difference in efficacy between the hyaluronic acid binding methods SpermSlow and PICSI .
No r and omised evidence evaluating sperm selection by sperm apoptosis , sperm birefringence or surface charge was found .