الفهرس 
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Abstract
The purpose of this study is to verify our clinical impact of using IMSI for male factor verses ICSI method. On this view only couples with low sperm concentration, low motility, high abnormality, or absence or low number of sperm with grade I ,II found in MSOME test are selected to this study by sibling their female oocytes.
Only couples who have 15 oocytes or more in retrieval step were selected for our study regardless to the maturation and abnormal oocytes. Abnormal oocytes clearly appear after denudation then by using stereo microscope GV, degenerate and abnormal oocytes were separated away from normal oocytes to be divided and ready to injection.
Mature oocytes (Metaphase II) which have a polar body in the PVS clearly identified on inverted microscope during injection step were accepted to our study to avoid external factors or stimulation protocols which are not IMSI indications. Metaphase I oocytes are excluded.
More than 6700 mature oocytes are randomly selected in 300 cycles to be injected by sperms were selected by ICSI classical method using 40X lens looking to normal oval head of motile sperms only and the same number of oocytes of the same cycles are randomly selected to be injected by sperms were selected by IMSI technique with high power lens (100X Oil) and optical zoom reach to 6000 times to classify selected sperm.
By IMSI technique and cronus software we can measure and calculate dimensions of sperm head and area then compare it to head size range according to WHO. This method take an extra time to find the best grade of sperm found in the case and more time to select. For example, 15 minutes at least needed to evaluate the sperm then classify the best sperm found if it was a Class II sperm so all sperm selected must be class II which take more time but with better results.
The huge number of mature oocytes and cycles in our prospective study, sibling oocytes retrieved in the same lab. Condition, and randomization of oocytes selected to each method increase the power of the study.
Mature oocytes must be injected carefully to avoid leaking of cytoplasm and quickly for exposure. Injection step was taken place in one manipulator.
Each injected groups (zygotes) placed in the same dish and the same day 5 pinch top incubator using the same media producer i.e. the two groups exposed to the same conditions.
Finally the statistical study show us that IMSI technique results much better than ICSI technique in fertilization rate, Number of blastocyst and quality of blastocyst.
Male factor is the main reason for ICSI which IVF was not able to fertilize oocytes with low concentration. Unexpected low fertilization rate for cases with absence of blastocysts due to sperm defect, So IMSI is recommended for male factor cases to ensure high fertilization rate and high quality blastocysts.
Implantation and pregnancy rates will be added in the study in the future to make a complete review of IMSI technique to find if there is a significant difference between the two sperm selection methods.