IVF / FERTILITY CARE, WOMEN HEALTH
The procedure of Embryo freezing is done along with fertility treatment in an IVF laboratory. It allows people to store gametes, reproductive tissue and embryos for later use. The first successful pregnancy resulting from freezing a healthy embryo took place in the 1980s. Since then, many people have frozen embryos and used them later. If your doctor has given option for frozen embryo transfer you must know the risks and advantages.
Embryo freezing is a laboratory procedure which begins with injection of hormones and other medications to stimulate the production of potentially fertile eggs. The eggs are then extracted from the ovaries, either for fertilizing in a lab or for freezing. A person may wish to freeze their eggs. Or, they may wish to use them at once to become pregnant. Fertilisation of eggs with sperm can be achieved either with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Often with in vitro fertilisation (IVF) or Intracytoplasmic sperm injection (ICSI) treatment, there may be good quality embryos left over after embryo transfer. Instead of discarding them, there is the option to freeze them to use in the future. A person can also freeze eggs and sperm, which are not fertilized. Embryos can be frozen to preserve fertility so it may be possible to have a baby at a later date.
When freezing is recommended?
Embryo cryopreservation is useful for surplus embryos during in vitro fertilisation. Patients who fail to conceive may become pregnant using frozen embryos in subsequent cycles. Successful patients in IVF treatment may come back later for frozen embryo transfer to achieve a sibling pregnancy.
Surplus oocytes or embryos resulting from fertility treatments may be stored for oocyte donation or embryo donation to another woman or couple. At times embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm.
When the endometrium is not ready for implantation embryos may be frozen for use at later date. This situation arises in patients with thin endometrium or oocyte donation and surrogacy programme.
There are certain situations like ovarian hyper stimulation when fresh embryo transfer becomes risky for the woman’s health. In this scenario embryos are frozen for later use.
Young patients undergoing cancer therapy can freeze their eggs, ovarian or testicular tissue for future use. Rare instances where mother is not fit to undergo a pregnancy may freeze embryos. They can come later for embryo transfer when the health issue is resolved.
How do people freeze embryos?
Cryo-preservation or cryo-conservation is a process where cells, tissues or organs are preserved by cooling to very low temperatures. Cryopreservation was applied to humans beginning in 1954 with three pregnancies resulting from the insemination of previously frozen sperm. There are two ways of freezing-
Slow freezing: This involves placing the embryos in sealed tubes, then slowly lowering their temperature. It prevents the embryo’s cells from ageing and reduces the risk of damage. However, slow freezing is time-consuming, and it requires expensive machinery.
Vitrification: In this process, the tissue is frozen after cryoprotection. The embryos are frozen so quickly that the water molecules do not have time to form ice crystals. This helps protect the embryos and increases their rate of survival during thawing. In the laboratory, large tanks filled with liquid nitrogen are available in which embryos are stored. The embryos remain in sealed containers at temperatures of -321ºF. At this temperature, almost no biological processes, such as ageing, can occur.
The tanks that contain frozen embryos are monitored 7 days a week. Each tank gets a physical inspection daily, looking for problems or signs of problems. The quantity of nitrogen in the tank is assessed as a means of monitoring for a possible slow leak or an impending tank failure. The nitrogen in the tank is topped up daily, since it continuously evaporates at a slow rate.
When to freeze embryos?
Not all embryos are suitable for freezing, so only good quality embryos will be chosen to freeze. Embryos can be frozen at different stages of their development – when they’re just a single cell, at the two to eight cell stage or later in their development (called the blastocyst stage). Eggs and sperm can also be frozen with out fertilising.
What is the success rates of thawing frozen embryos?
The process of thawing an embryo after cryopreservation has a relatively high success rate, and research suggests that women who use thawed embryos have good chances of delivering healthy babies.
How long can embryos stay frozen?
Procedures for human embryo freezing were developed in 1984 and only went into widespread use in the late 1980s. This means that the longest time a human embryo has been stored is 25-30 years and, typically, patients that have left embryos in storage for this long are not coming back for them.
In theory, a correctly frozen embryo can remain viable for any length of time. But different laws regulate length of freezing in different countries. Most countries allow freezing up to 10 years.
The embryos remain in sealed containers at temperatures of -321ºF. At this temperature, almost no biological processes, such as aging, can occur.
Frozen or fresh embryos – which is better?
A study published in the International Journal of Reproductive Biomedicine looked at the results of over 1,000 instances of embryo transfer involving either fresh or frozen embryos.
The researchers found no statistical difference between the types of embryos, in terms of pregnancy rates or fetal health.
Freezing of human sperm, eggs and embryos @ Femelife
Within the laboratory at Femelife we have a tissue bank where we freeze and store oocytes (eggs), sperm and embryos for our patients. The bank has personnel and computerised system for full time monitoring. The procedure is done under supervision of the lab director, and is licensed by the ICMR, Govt of India. All tissue in the bank is stored frozen in liquid nitrogen at a temperature of -196C in vacuum lined tanks that are computer controlled and monitored 7 days a week with a dedicated alarm system. The embryologists are responsible for maintaining the bank and no other employee has access to it.
The process of freezing eggs vs. freezing embryos
The egg freezing procedure and the embryo freezing procedure both start the same basic way with hormone medication, injected over for 8–12 days, that stimulates the ovaries to produce multiple eggs. Freezing multiple eggs increases the chances of finding healthy eggs later. Study have shown that embryos survive the freeze thaw process better than eggs. The freezing of eggs is a recent procedure and may need further development for wide usage.
What are the risks associated with cryopreservation of embryos and human gamete?
Risk of contamination
Since viruses and bacteria can also survive at cryogenic temperatures it needs special attention. The risk of cross-contamination, i.e., transfer of bacteria or other microorganisms from liquid nitrogen to stored samples, is should be taken care. Some investigators have suggested that liquid nitrogen should be sterilised in order to prevent such contamination when so-called open cryodevices, which bring the sample in direct contact with the liquid, are utilised.
Risk of reduced or lost viability
Long-term storage does not impact viability/developmental potential of slow-frozen embryos. Cryostorage appears to be safe for slow-frozen oocytes as well.
Risk of specimen loss
In contrast to the risk of infection or time-related decrease in viability, under current practices the risk of loss of cryopreserved gametes and embryos due to human error or equipment failure is relatively high. It is the responsibility of the IVF laboratory to take proper care of the procedure.
Risks inherent in shipment and handling
At times, frozen eggs or embryos need transportation for further use according to patient convenience. The shipping procedure carries risk of vessels being exposed to elevated ambient temperature and air pressure, vibration/other physical shock, and horizontal storage.
A two-step removal of vitrified samples, during which the sample is held in the neck of a dewar in nitrogen vapour for 15 seconds, leads to reduced viability due to thermodynamic instability and devitrification at relatively low temperatures. Cross country transportation of cryopreserved eggs and embryos are guarded by certain laws.
Embryo freezing is a type of fertility preservation. It may be useful for women with cancer who want to have children after having radiation therapy, chemotherapy, or certain types of surgery, which can cause infertility. Also, called embryo banking and embryo cryopreservation it is widely used in IVF treatment.
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Health, WOMEN HEALTH
food in pregnancy
Eating during Pregnancy
A balanced diet provides all of necessary nutrients in proper proportions for adequate nutrition, function and development of body. In pregnancy, balanced diet is essential for growth of the baby and wellbeing of mother. Without good nutrition mother is more prone to disease, infection and restriction of growth of foetus.
Extra calories / eating for two
During the first three months’ calorie needs of pregnant mothers are basically the same as they were before pregnancy. However, pregnant women should add 200 calories to their usual dietary intake during the second trimester, and 300 calories during their third trimester when the baby is growing quickly.
Brain growth of baby
Baby’s brain starts forming just three weeks after conception and it undergoes rapid changes during pregnancy. Majority of brain growth is completed when the baby is born and later it undergoes few fine changes only. Food containing docosahexaenoic acid (DHA) is important in pregnancy for helping the brain and central nervous system mature. Iodine deficiency during pregnancy is the leading cause of preventable mental health.
Foods to avoid
Avoiding certain foods in pregnancy is recommended for maternal and fetal well-being. Pregnancy is a state of lower immunity and pregnant women catch infections easily. Moreover, not all medications can be used to treat diseases in pregnancy. Hence it is safer to avoid certain foods in pregnancy which can give rise to food poisoning or infections. Fish such as shark, swordfish, king mackerel, and tilefish have high mercury levels and must be avoided. Smaller fish have less mercury content can be chosen instead as their longevity in water is short such as fresh water fish. Similarly, smoked meat or fish should be avoided as they can cause infections. Raw uncooked eggs or poultry, unpasteurised milk and milk products, raw sprouts, unwashed fruits or vegetables are not advisable as well. Pregnant women should carefully avoid excess caffeine, alcohol or tobacco as these could harm the baby. Artificial sweetners, sugar rich foods, canned foods and foods containing nitrates as in frozen meat are better avoided in pregnancy.
Vegetarian diet in pregnancy
Vegetarians can meet their protein needs by eating select milk and egg foods, protein-rich vegan foods like nuts, hummus, and beans, soy milk, soy cheese, soy yogurt, and tofu. Pregnant women require an additional 45 grams of carbohydrates per day which can be obtained from fruits, vegetables, grains, and several dairy products. Nuts and vegetable oils can provide the dietary fat requirement for pregnant women. Carbohydrates enriched with folic acid reduce the rate of birth defects. Milk, yogurt, dark green leafy vegetables such as spinach, dried beans and peas and cheese are good sources of calcium.
Role of dietary fibres in pregnancy
Dietary fibre is a nutrient that cannot get digested by human gastrointestinal tract. It absorbs water and helps bowel movements. Insoluble fibre like vegetables (especially dark green leafy ones), root vegetable skins, fruit skins, whole wheat products are essential during pregnancy to prevent constipation. Soluble fibres absorb water, bind to fatty acids and slow down sugar absorption. Some types of soluble fibres are: kidney beans, sprouts, broccoli, spinach, apple, orange, grapefruit, grapes, prunes, grains, oatmeal etc.
Choosing fruits and vegetables
Pregnant women need at least 70 mg of Vitamin C daily, which is contained in fruits such as oranges, grapefruits and honeydew, and vegetables such as broccoli, tomatoes, and sprouts. At least 2-4 servings of fruit and 4 or more servings of vegetables daily is recommended during pregnancy. Fresh fruit contains lots of essential vitamins and nutrients and eating plenty of fresh fruit during pregnancy can help wellbeing of mother and baby. Broccoli and dark, green vegetables, such as kale and spinach, contain vitamin C, vitamin K, vitamin A, calcium, iron, folate and potassium which are essential in pregnancy.
Planning meals in pregnancy
Pregnant women should plan for small frequent meals. Lighter meals help prevent gastrointestinal upsets like abdominal distension and vomiting. Fatty foods like fried, baked snacks can be replaced by servings of fruits and nuts. Drinking 3-4 litres of water daily is essential during pregnancy.
Foods to avoid vomiting of pregnancy
Foods with high content of sugar, fat or salt lead to vomiting in pregnancy. A large evening meal can give rise to morning sickness. Having small and frequent meals and drinking a lot of cold water suppresses vomiting sickness of pregnancy. At times, fast foods and street foods can cause food poisoning and better be avoided in pregnancy.
Vitamins and minerals in pregnancy
The lack of calcium, iron, iodine and other vitamins lead to baby’s learning disabilities, delay in language development, behavioural problems, delayed motor skill development, and a lower I.Q. Deficiency of Folic acid in pregnancy leads to severe malformations of the brain and spinal cord. Folic acid is found in green leafy vegetables, broccoli, beans, citrus fruits and liver.
Eating well during pregnancy is essential and the guidelines for eating well for a healthy pregnancy are simple and easy to follow. Healthy eating keeps the mother safe throughout pregnancy and provides baby the essential nutrients they need inside the uterus.
IVF / FERTILITY CARE, WOMEN HEALTH
Why HSG (Hysterosalpingogram) is done?
Hysterosalpingogram ( HSG) is a type of X-Ray of abdomen to know the condition of the fallopian tubes. If the fallopian tubes are blocked then couple may have difficult in conceiving, it is required to check whether tubes are open or not in cases of infertility. It’s also used to investigate miscarriages resulting from abnormalities within the uterus such as tumour masses, adhesions and uterine fibroids.
What is HSG
What is a Hysterosalpingogram (HSG)?
HSG is a diagnostic X-Ray procedure that usually takes around 15 minutes to perform. It is usually done before ovulation around 10 -12 days after menstruation. This is done on an outpatient basis.
How the patient is prepared for HSG?
The doctor usually obtains history regarding pregnancy and any allergies as HSG should not be done on a pregnant woman. Any kind of allergies should be noted as the dye used in this procedure may cause severe reactions in such people. This procedure should not be performed in inflammatory condition like chronic pelvic infection or an untreated sexually transmitted disease. Since the dye used may damage a developing foetus doctors advise to take contraceptive pills in the cycle when HSG is done in order to prevent pregnancy. The patient is also given antibiotics to prevent infection and also at times a pain killer to reduce the discomfort during the procedure.
How is a Hysterosalpingogram done?
Hysterosalpingography uses a real-time form of x-ray called fluoroscopy to examine the uterus and fallopian tubes
A woman is positioned under a fluoroscope (an x-ray imager that can take pictures during the study) on a table. The doctor then examines the patient’s uterus and places a speculum in her vagina. Her cervix is cleaned, and a cannula is placed into the opening of the cervix. A liquid containing iodine (a fluid that can be seen by x-ray) is slowly pushed through the cannula. The contrast is seen as white on the image and can show the contour of the uterus as the liquid travels from the cannula, into the uterus, and through the fallopian tubes. If the tubes are blocked the dye doesn’t pass through and may cause swelling of the tubes called hydrosalpinx.
After the HSG, a woman can immediately return to normal activities but refrain from intercourse for a few days.
Does HSG cause pain?
An HSG usually causes mild or moderate cramping pain for about an hour. However, some women may experience cramps for several hours. These symptoms can be greatly reduced by taking medications used for menstrual cramps like pain killers before the procedure or when they occur.
What are the risks of HSG?
HSG is considered a relatively safe procedure. However, some complications mild or serious can happen in less than 1% of the time. There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose for this procedure varies. Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation.
In the event of a chronic inflammatory condition, pelvic infection or untreated sexually transmitted disease, be certain to notify the physician or technologist before the procedure to avoid worsening of infection.
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
- The most common serious problem with HSG is pelvic infection. This usually occurs when a woman has had previous tubal disease (such as a past infection of chlamydia). In rare cases, infection can damage the fallopian tubes or make it necessary to remove them. A woman should call her doctor if she experiences increasing pain or a fever within 1-2 days of the HSG.
- Fainting – Rarely, some woman may get light-headed during or shortly after the procedure and faint due to a vasovagal attack.
- Iodine Allergy – Rarely, a woman may have an allergy to the iodine contrast used in HSG. A woman should inform her doctor if she is allergic to iodine, intravenous contrast dyes, or seafood. Women who are allergic to iodine should have the HSG procedure performed without an iodine-containing contrast solution. If a woman experiences a rash, itching, or swelling after the procedure, she should contact her doctor.
- Spotting – Spotting sometimes occurs for 1-2 days after HSG. Unless instructed otherwise, a woman should notify her doctor if she experiences heavy bleeding after HSG.
What are the limitations of HSG?
Hysterosalpingography only sees the inside of the uterus and fallopian tubes. Abnormalities of the ovaries, wall of the uterus, and other pelvic structures may be evaluated with MRI or ultrasound. Alternatively, a surgical procedure to directly view the tubes (laparoscopy) can be done which is more accurate than HSG.
What is the next step if tubes are found to be blocked on HSG?
Patients may undergo revaluation of tubes with laparoscopy or may be suggested to go for IVF. In vitro fertilization (IVF) is a procedure which can bypass the function of the tubes and can achieve pregnancy in cases with the blocked fallopian tubes.
What is HSG
IVF / FERTILITY CARE, WOMEN HEALTH
What is premature ovarian failure?
When a woman’s ovaries stop working before age 40, she is said to have premature ovarian insufficiency (POI) or premature ovarian failure (POF) also, known as premature menopause, is a common condition, affecting 1–2% of women younger than 40 years of age and 0.1% of women, younger than 30 years of age. When this happens, a woman’s menstrual cycles become irregular and stop. Her ovaries stop making hormones such as oestrogen and progesterone and she stops releasing eggs (ovulating) regularly or at all.
Some women develop POF when they are teenagers, even before they start to have menstrual periods. If that happens, the teen will never experience normal function of her ovaries. For other women experiencing POF, their ovaries may continue to intermittently release (ovulate) eggs and make hormones; these women may continue to have menstrual cycles for months or years before their ovaries completely shut down. For this reason, the currently used term POI is preferred to the older terminology “premature ovarian failure (POF).
Causes of Premature Menopause
In human females, the process of ovarian follicular maturation, or maturation of eggs, is a highly organised and complex process. Maturation of Eggs is the progressive maturation of small primordial follicles that progress to become large ovulatory follicles. When follicles eventually mature, the oocytes (eggs) are released from the surface of the ovary. They are collected by the uterine tube, and proceed to become fertilised.
The causes of POF remains unknown in most cases. A genetic cause of POF is identified in few patients, i.e. in 5-7% of the total cases, whereas causes remains most often undiscovered. Fragile X syndrome is one of the genetic causes of POF which can be transmitted in the family.
Women receiving cyclophosphamide for either kidney diseases or rheumatoid arthritis are at risk of developing POF.
Malnutrition and cigarette smoking are perhaps the only consistent environmental features associated with an earlier menopause.
The first known significant cause is damage to the ovaries, such as that caused by iatrogenic agents like chemotherapy or radiotherapy or pelvic surgery may be
associated with ovarian failure. Surgical menopause may be induced by removal of ovaries, but interestingly hysterectomy to remove the uterus is also associated with an earlier menopause.
Premature ovarian failure (POF) may be considered as an autoimmune endocrine disease. Autoantibodies and lymphocyte subset changes are associated with premature ovarian failure. This problem can run in family as well.
What POF women experience?
Women with POF experience menopausal symptoms,
such as hot flushes, night sweats and vaginal dryness, In addition, there is increased risk of developing osteoporosis because of the lengthened time of exposure to reduced oestrogen similar to those going through a natural menopause.
For most women, it can be an unexpected and distressing diagnosis, with unpleasant symptoms, but made worse by the fact that it coincides with infertility.
Premature ovarian failure (POF) is a disorder associated with female infertility, and it affects approximately 1% of women under the age of 40 yr . It can be attributed to two major mechanisms: follicle dysfunction and follicle depletion .
Despite having amenorrhea and markedly elevated serum gonadotropin levels, some women with karyotypically normal can go to spontaneous premature ovarian failure. Nevertheless, they have ovarian follicles that function intermittently. Graafian follicles capable of responding to these high FSH levels are faced with high serum LH levels as well, which might prevent normal follicle function.
Premenopausal women may be at risk for the development of osteoporosis. However, bone loss in women with amenorrhea from other causes has not been assessed. Women with POF have diminished general and sexual well-being and are less satisfied with their sexual lives than other women
TREATMENT
Many women with POF would benefit from symptom relief by the use of exogenous steroids, to compensate for the loss of ovarian hormone estrogen and possibly progesterone and androgens. Menopausal symptoms, such as hot flushes, night sweats and vaginal dryness can be relieved by oestrogen replacement, such as sequential HRT or oral contraceptive pill.
Infertility In POF
Infertility is a significant issue for most women undergoing POF. A number of treatment regimens have been evaluated with the aim of restoring fertility. However, treatments with clomiphene, Gonadotrophins, GNRH agonists or immunosuppressants do not significantly improve the chance of conception and are not used.
The only reliable fertility treatment is the use of donor eggs. It is an assisted reproductive procedure that is widely practised in most countries. At present, in vitro maturation of immature follicles is possible. But in vitro growth and maturation from stored ovarian tissue is not reliably achievable in humans. For women with impending POF, there may not be any alternatives. Young women about to begin cancer treatment are encouraged to attempt a cycle of IVF if time permits. They can go for storing embryo or eggs for later use.
In addition, young women may store ovarian tissue, in the hope that at a later stage their tissue can be reimplanted, or that the use of in vitro growth and maturation of immature follicles may restore fertility
Women suffering from oestrogen deficiency should be recommended a number of measures to protect against osteoporosis. It includes increased physical exercise, eating a diet rich in calcium and vitamin D and avoiding risk factors such as smoking and high alcohol intake.
Women with POF are advised to undergo HRT until the normal age of menopause addition of testosterone to HRT to improve sexual function and wellbeing.
Premature ovarian failure (POF), a major life-changing condition that affects a significant proportion of young women. It remains an enigma and the researcher’s minefield. As women increasingly survive childhood cancers due to improved iatrogenic interventions, the number of POF sufferers will inevitably increase.
Patient Counselling
When primary ovarian insufficiency is diagnosed in the adolescent female, the patient and her family are often unprepared for such news with its implications for compromised fertility and the need for long-term hormonal therapy. Adolescents may demonstrate myriad emotions ranging from apathy or denial and these emotions may be different from those of their parents or guardians. Parents can provide valuable insights about their daughters’ ability to appreciate the significance of the diagnosis to the treating practitioner and help in managing the situation.
IVF / FERTILITY CARE, WOMEN HEALTH
ovarian drilling
What is ovarian drilling and how does it work?
ovarian drilling – In women with PCOS ovulation doesn’t occur regularly and usually they have ovaries with a thick outer layer. The ovaries make more testosterone, the male type of hormone. High testosterone levels lead to irregular menstrual periods, acne, and extra body hair.
Ovarian drilling is done to break the thick outer surface and destroy some of the testosterone producing tissue made by the ovaries. This can help the ovaries release an egg each month and start regular monthly menstrual cycles. This may reduce symptoms of excess testosterone
How drilling of ovary is done?
A minimally invasive surgery called laparoscopy is used for ovarian drilling. A thin, lighted telescope (laparoscope) is put through a small surgical cut (incision) near the umbilicus. A tiny camera is used to see the ovaries. The surgeon inserts tools through other tiny incisions in the lower belly and makes very small holes in the ovaries. This helps to lower the amount of testosterone made by the ovaries.
What are the benefits of drilling ovary?
About 50% of women get pregnant in the first year after surgery. Some women still may not have regular cycles after the surgery. Others may have other fertility problems (such as blocked tubes or a low sperm count) that can prevent pregnancy. Some women after a short period of regular ovulation may go back to previous irregular cycles.
For some women with PCOS, ovarian drilling will not fix the problems with irregular periods and ovulation, even temporarily. However, ovarian drilling can help a woman respond better to fertility medicines.
What are the risks of drilling ovary ?
There are certain risks of the surgery done for ovarian drilling .
Some of the risks are related to surgery. As with all surgical procedures, there are risks of bleeding, anaesthesia, and infection. Also, laparoscopy can cause injury to the bowel, bladder, and blood vessels. Very rarely, there is a risk of death.
There are also risks to fertility. If there is too much damage to the ovary during the ovarian drilling procedure, a woman may enter menopause at a younger age than expected. After the procedure, adhesions (scarring) can form between the ovaries and the fallopian tubes, making it hard to get pregnant. Most important in many women the beneficial effects are for too short period and they immediately go back to the previous status.
ovarian drilling
IVF / FERTILITY CARE, WOMEN HEALTH
What is intracytoplasmic sperm injection (ICSI)?
ICSI treatment is an option for conceiving with male infertility. It is an advanced fertility treatment which gives best success in the hands of experts.
In human being formation of an embryo from a woman’s egg and a man’s sperm is a very complex phenomenon. The sperm of a man is a moving cell inside the body and it must reach to the egg at appropriate time to fertilize it as the released egg from ovary can survive for only 24 hours. At times this process doesn’t happen due to any of following problems in the man
- Sperm quantity may be too low – oligospermia
- Azoospermia- No sperms are found
- Defects in sperm movement – Asthenospermia
- Sperm cannot penetrate the egg due to a thick covering – thick zona
Before a man’s sperm can fertilize a woman’s egg, the head of the sperm must attach to the zona of the egg. Once attached, the sperm penetrates through the outer layer to the inside of the egg (cytoplasm), where fertilization takes place.
Sometimes the sperm cannot penetrate the outer layer, for a variety of reasons. The egg’s outer layer may be thick or hard to penetrate or the sperm may be unable to swim. In these cases, a procedure called intracytoplasmic sperm injection (ICSI) can be done to fertilize the egg inside the labaoratory. During ICSI, a single sperm is injected directly into the cytoplasm the egg.
How ICSI is different from IVF?
There are two ways that an egg may be fertilized in the laboratory: IVF and ICSI. In traditional IVF, 50,000 or more swimming sperm are placed next to the egg in a laboratory dish. Fertilization occurs spontaneously when one of the sperm enters into the cytoplasm of the egg. In the ICSI process, a tiny needle, called a micropipette, is used to inject a single sperm into the center of the egg. Fertilization achieved through ICSI can be up to 80-90% whereas through IVF it is aound 50 -60 %. With either traditional IVF or ICSI, once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 2 to 5 days before it is transferred to the woman’s uterus (womb).
Why ICSI is needed?
ICSI helps to overcome fertility problems, such as:
- The male partner produces too few sperm to do artificial insemination (intrauterine insemination [IUI]) or IVF.
- The sperm may not move in a normal fashion, hence cannot reach up to the egg in time.
- The sperm may have trouble attaching to the egg , Intra cytoplasmic sperm injection overcomes this.
- Azoospermia due to a blockage in the male reproductive tract may keep sperm from getting out. In these couples the sperms are obtained directly from Testes through a minor procedure like PESA or TESE. ICSI helps these couples to achieve a pregnancy even though no sperms are found in semen analysis.
- At times, traditional IVF fails to create embryos in some patients. ICSI can achieve fertilization in such patients regardless of the condition of the sperm.
- ICSI is used along with IVM (In vitro maturation of eggs).
- ICSI is necessary where frozen eggs are used for fertilization.
Does ICSI work for all?
ICSI fertilizes up to 80% of eggs. But certain issues may occur during or after the ICSI process:
- Some or all of the eggs may be damaged. Hence it is advisable to take help of an expert embryology department.
- The egg might not grow into an embryo even after it is injected with sperm. This can happen due to any inherent problem in any one of the couple.
- The embryo may stop growing after fertilization due to several reasons.
Once fertilization takes place, a couple’s chance of achieving pregnancy is same for IVF and ICSI. Chances of Pregnancy in humans is up to 30-40 % even with very good embryos. This is due to the low implantation capacity of human uterus.
ICSI treatment
Can ICSI affect a baby’s development?
If a woman gets pregnant naturally, there is a 1.5% to 3% chance that the baby will have a major birth defect. The chance of birth defects associated with ICSI is similar to IVF, but slightly higher than in natural conception.
The slightly higher risk of birth defects may actually be due to the infertility and not the treatments used to overcome the infertility.
Certain conditions have been associated with the use of ICSI, such as Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, or sex chromosome abnormalities. They are thought to occur in far less than 1% of children conceived using this technique.
Some of the problems that cause infertility may be genetic. For example, male children conceived with the use of ICSI may have the same infertility issues as their fathers. Couple should go through a counselling process at a standard ICSI center with the help of Infertility specialists and embryologists.
