What is ICSI ?
ICSI is a procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. Injecting sperm through the egg’s shell helps the sperm fertilize directly bypassing the need to penetrate the shell.
This procedure is most commonly used to overcome male infertility problems.
When ICSI treatment is suggested?
These are few conditions where your doctor will prefer ICSI treatment over IVF.
- 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
Pre ICSI workup
- Ovarian Stimulation
- Ovulation Induction
- Oocyte retrieval
- Semen collection & preparation
What are the procedures after ICSI?
- Embryo development
- Implantation or Cryopreservation
What you should know before ICSI treatment?
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.
Simulating follicles and retrieving eggs
Ovarian stimulation (agonist/antagonist) can be done by any of the ways
- Short/mild protocol
- Long/standard protocol
- Ultra short/modified protocol
Hormonal treatment to stimulate the ovaries produces several eggs. Monitoring the follicular growth and count by ultrasound scanning is done by your fertility specialist.
The process of egg 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 under analgesia or anesthesia. Aspiration- aspirating needle inserted into the follicle to aspirate the follicular fluid containing oocyte/OCC by applying suction.
- Semen collection and preparation
- Frozen donor sperm can also be used after matching
- Semen preparation by density gradient or swim up method
After oocyte retrieval your embryologist identifies the of oocytes in the follicular fluid.
The embryologist will denude of the oocytes and separate the mature eggs.
- She prepares the ICSI dish before starting the process.
- 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.
Advantages of ICSI Treatment
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
- Damage to the embryos
- Multiple pregnancies
- Risk of OHSS (stimulation)
- Birth defects
Fertilization and pregnancy success with ICSI Treatment
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.