Could sperm grade under high magnification condition predict IMSI clinical outcome

Abstract Objective The aim of this study was to examine whether injection of first-best morphology grade selected spermatozoa improves live birth rate (LBR) compared to intracytoplasmic morphologically selected sperm injection (IMSI) using second-best grade sperm. Study design In this prospective observational study, 132 patients were enrolled. Inclusion criteria were the presence of severe male factor (normal spermatozoa n  = 41). The primary endpoint was LBR. Results LBR following IMSI was not statistically different using first- (33.3% (13/39)) or second-best morphology grade spermatozoa (28.9% (15/52)). Our study shows that sperm grading under high magnification using Vanderzwalmen's classification is not correlated to IMSI outcome. Conclusion We do not validate Vanderzwalmen classification in our external and prospective series. These results point out the need for improving our knowledge about the impact of observed vacuoles under high magnification condition.