ICSI can be used as a part of standard IVF ( In Vitro Fertilization) treatment to help you and your spouse conceive your own baby even if there are severe abnormalities in the semen reports of your partner. It is an advanced micromanipulation procedure where a single sperm is directly injected into the center of an egg under a special magnification microscope. ICSI only requires one sperm for each egg. During ICSI the sperm doesn’t have to travel to the egg or penetrate the outer layers of the egg. This means that it can help couples where the man’s sperm can’t get to the egg at all or can get to the egg, but for some reason can’t fertilize it. The success rates for ICSI are higher than if you use conventional IVF methods. Still a lot depends on your particular fertility problem and your age.
With the ability to fertilize an egg with just one sperm, many infertile couples are finally becoming pregnant!
In the early 1990’s the ICSI technique was developed for male factor infertility and as a remedy for male infertility, ICSI has completely revolutionized infertility treatment. ICSI has been a tremendous benefit to IVF for over a decade and has revolutionized the treatment for couples that have severe male infertility. Know that even if there are no issues with your partner’s sperm, your doctor may still recommend ICSI with IVF in some cases. ICSI is often helpful even for couples that have not been successful with IVF in previous cycles. The ICSI procedure is becoming more common in IVF clinics because it virtually guarantees that the sperm penetrates the egg. Over half of all IVF cycles performed in the world are using ICSI. And, the vast majority (87 percent) of couples dealing with male factor infertility used ICSI with their IVF cycles. It is still important to note that ICSI isn’t the solution to every male fertility problem.
The intracytoplasmic sperm injection process takes place during IVF. It is often performed for couples that are dealing with male factor infertility .
It differs from In Vitro Fertilization (IVF) slightly. In this treatment, embryologists selects a single sperm to inject directly into an egg, whereas in the fertilization process many sperms are placed in a dish near the egg. Intracytoplasmic sperm injection (ICSI) is an In Vitro Fertilization procedure in which a single sperm is injected directly into an egg in order to achieve fertilization using a technique called micromanipulation. Micromanipulation uses a special microscope, along with very small surgical tools, to pick up and handle one single sperm, injecting it directly into an egg. Once mature eggs have been obtained from the female the ICSI procedure is performed under an inverted microscope using multiple specialized micromanipulation devices (micromanipulators, microinjectors and micropipettes) that enable the embryologist to select and then pick up individual sperm in the tiny, hollow ICSI needle. Once loaded with the single sperm, the hollow needle is pierced through the outer shell of the egg and egg membrane and the sperm is injected into the cytoplasm of the egg. This requires a greater magnification, precision and micromanipulation of gametes.
There are five main steps to the ICSI procedure:
- A sperm sample is taken from your partner’s semen or surgically extracted from his testes or epididymis.
- Your eggs are surgically extracted from your ovaries.
- Using a tiny hollow needle, one sperm is carefully injected into an egg.
- After injection, the fertilized egg is observed for growth and development.
- Once normal growth is observed, the embryo will be implanted into your uterus where it has a chance to implant and grow.
As with standard IVF treatment, you will be given fertility drugs to stimulate your ovaries to develop several mature eggs for fertilization. When your eggs are ready for collection, your spouse may have to ejaculate and give the semen sample. Sometimes, as in cases of obstructive azoospermia, he may need to undergo surgical sperm retrieval procedures like TESA/PESA/TESE which already would have been pre decided and discussed with you both.
The retrieved sperm are frozen.
Any discomfort felt by your spouse/partner should be mild and can be taken care by painkillers.
After giving you a short general anaesthetic, the doctor will remove your eggs using a fine, hollow needle. An ultrasound helps the doctor to locate the eggs. The embryologist then isolates individual sperm in the lab and injects them into your individual eggs.
Two days later the fertilized eggs become balls of cells called embryos. The procedure
then follows the same steps as in IVF. Extra embryos, if there are any, may be frozen in case this cycle isn’t successful.Embryos may be transferred two to three days after fertilisation, or five days after fertilisation. Five days after fertilisation the embryo will be at the blastocyst stageThe doctor transplants one or two embryos into your uterus and through your cervix using a thin catheter called as fresh cycle embryo transfer. Extra embryos can be cryopreserved. If all goes well, an embryo will attach to your uterus wall and continue to grow to become your baby. After about two weeks, you will be able to take a pregnancy test.
Who can and should be treated with ICSI?
This method of fertilization has been traditionally & particularly effective in cases of male infertility resulting from obstructive azoospermia (meaning absence of sperm in the semen, possibly caused by a blockage where sperm cannot pass from testis and out through the penis) and when the sperm has low count and/or low motility( capacity to swim fast) or a high percentage of abnormally shaped sperm. ICSI treatment is a more complex and advanced procedure of IVF and may involve some advanced techniques to extract the sperm in case the male patient is suffering from infertility disorders.
- For obstructive cases since the sperms can’t be ejaculated but can be collected from the testicles or from the duct where sperm is stored (epididymis), theyare directly extracted from testis or epididymis for use with ICSI with surgical treatments like TESA, PESA, TESE.
Indications of ICSI are ever increasing and newer candidates are constantly getting added. Some of the other indications of ICSI use are:
· Prior failed IVF
- In cases when standard IVF results in less than 30% of eggs fertilized or no fertilization at all.
· This may be needed if your spouse has had an irreversible vasectomy or injury.If your partner has had a vasectomy, the ICSI procedure may help you conceive. This may be especially helpful if your partner tried to have a vasectomy reversal that was unsuccessful, or if he doesn’t want to have the vasectomy reversed. During a vasectomy reversal or in a quick office procedure, a surgeon is often able to remove your partner’s sperm from his testes. These sperm can be frozen for later use with IVF and ICSI.
· Problems with getting an erection and ejaculating, due to spinal cord injuries or diabetes, for example
· Poor ovarian reserve
· Advanced maternal age
· ICSI can also be used to help couples with unexplained infertility, though experts haven’t found that ICSI makes pregnancy any more likely than standard IVF.
· Sperm unable to penetrate through the outer layer of your egg or production of anti sperm antibodies.
What are advantages ICSI?
ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you like in severe sperm issues.
ICSI doesn’t appear to affect how children conceived via the procedure develop mentally or physically.
It has been a major scientific leap in the development of assisted reproductive treatments providing hope to so many couples with severe male factor infertility, obstructive azoospermia , repeated failed IVFs.
Are there any shortcomings of ICSI ?
· There were some concerns about ICSI like eggs may become damaged or the embryo might fail to grow after the fertilization or speculations that the ICSI process might lead to higher rates of genetic defects compared to other fertility treatments. But none of these are found statistically significant. Also, the birth defects if at all seen, commonly associated with ICSI can usually be fixed with surgery. There are no concerns found on long term followup.
· ICSI is still may not be the answer to all male infertility problems. Sometimes a hormonal test may confirm testicular failure and one may resort to donor sperm option only.
· Males with severe Oligospermia (count < 5 million sperm/cc) should have a karyotype performed since they are at greater risk for having chromosomal abnormality which may be passed further on to any sons you have together.
· Alike IVF, ICSI treatment may also lead to Multiple Pregnancies, in which, multiple embryos are transferred back to the uterus. Multiple pregnancies are associated with other health risks like low birth weight, premature labour, miscarriage, need for c-section, still birth and other infant health problems
At Anmol Fertility & IVF Centre, you and your spouse will be offered counselling before the process, to help you through both the decision and the process
What are the success rates of ICSI?
Using the Intracytoplasmic Sperm Injection treatment, the fertilization rate is recorded to be about 70-85% of the sperms injected under this treatment, which is different from pregnancy success rate. Again, the pregnancy success rate by IVF treatment using ICSI technique is also higher than that not using the technique. The percentage of cycles using ICSI which result in a live birth are 35-40 per cent if you are under 35.The success rate may also vary with individual factors like ICSI technique used, skill of the specialist performing the procedure, embryo transfer skills, quality of the lab used and such like. The younger you are, the healthier your eggs usually are, and the higher your chances of success.
Male infertility puts bigger challenge as it is much complex than the female infertility process. ICSI is by far the most successful form of treatment for men who are infertile. It is fascinating that thanks to the scientific advancements, we now have the ability to fertilize an egg with just one sperm, helping many infertile couples get pregnant. Though ICSI results in more success rates, you must be very sure about the pros and cons of the treatment as well this amazing technology called ICSI should be put to use judiciously depending on the case.