ICSI is an advanced fertility treatment for male infertility. This gives best success in the hands of expert IVF doctors and embryologists.

INTRACYTOPLASMIC SPERM INJECTION

INTRODUCTION

Procedure in which a single sperm cell is injected directly into the cytoplasm of an egg
Injecting sperm through the egg’s shell so that the sperm does not need to penetrate the shell in order to fertilize the egg
This procedure is most commonly used to overcome male infertility problems

INDICATION

Teratozoospermia
Azoospermia
Oligozoospermia
Asthenozoospermia
Immunological factors (antisperm antibodies)
Testicular cancer
Frozen semen sample
Previous failure IVF attempts
Sperms retrieved by surgical techniques(TESA, PESA, MESA,TESE)
Pre-implantation genetic diagnosis

ICSI

Pre IVF workup
Ovarian Stimulation
Monitoring
Ovulation Induction
Oocyte retrieval
Semen collection & preparation
ICSI
Embryo development
Implantation or Cryopreservation

ICSI – STEPS

Pre workup
Patient’s history
Counselling
All couples wishing to undergo (ICSI) should be counselled to the commencement of treatment. Counselling should address any concerns the couple may have also provide evidence based information regarding the likely outcomes and what to expect while undergoing intracytoplasmic sperm injection.
Couples should also be aware that (ICSI) may fail, and be encouraged to discuss alternative options (e.g. use of donor sperm, adoption). In addition, couples undergoing (ICSI) should be aware of and discuss the increased risk of congenital abnormalities, particularly in male offspring.

ICSI – STEPS

Ovarian stimulation (agonist/antagonist)
Short/mild protocol
Long/standard protocol
Ultra short/modified protocol

Hormonal treatment to stimulate the ovaries to produce several eggs

Monitoring the follicular growth and count by ultrasound scanning

Ovulation induction

ICSI – STEPS

Oocyte retrieval
This process happens after 34-36 hours of the hCG trigger
It is a laparoscopic surgery guided by the ultrasound
The mature ovarian follicles are drained; the follicular fluid is sent to the lab to locate the oocytes
Analgesia/Anesthesia
Aspiration- aspirating needle inserted into the follicle to aspirate the follicular fluid containing oocyte/OCC by applying suction.
Identification of oocytes in the follicular fluid
Denudation of the oocytes

ICSI – STEPS

Semen collection and preparation
Semen from the partner / donor
Semen preparation by density gradient or swim up method

ICSI

ICSI dish was prepared
The mature egg is held with a holding pipette.
A very sharp and hollow needle is used to immobilize and pick up a single sperm.
This needle is then inserted through the zona and in to the center (cytoplasm) of the egg.
The sperm is injected by aspirating some of the cytoplasm along with the sperm and releasing them back.
Injected eggs are placed in CO2 incubator.
The eggs are checked for fertilization after 22 hrs.

ICSI

PROS

It provides the male partner an opportunity to father a child using his own sperm.
Couples can also go for ICSI before Opting to donor sperm for viable sperms.
ICSI can be performed even if the man has undergone a vasectomy. In that case, viable sperm can be extracted directly from testicles using special sperm retrieval techniques and injected into the egg

CONS

Damage to the embryos
Multiple pregnancies
Invasive
Risk of OHSS (stimulation)
Birth defects

Fertilization and pregnancy success

The ICSI procedure fertilizes 50 to 80 percent of eggs.
Success is 35% in women aged 30 to 35, 20% at 35 to 40, and less than 10 % after 40.
Blastocyst embryo transfer at the 5–6-day stage, generally has higher success rates than embryo transfer at the 2–3-day stage.
Depending on the age of the couple, hormone levels, disease (Diabetes mellitus, hypertension, etc.) and lifestyle (excess weight, stress, alcohol and nicotine use, etc.)
the average egg quantity and quality tends to be better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs – as compared to cases with unexplained infertility. Some unexplained cases have reduced egg quantity and/or quality – which lowers the chances for a successful IVF outcome.