Intracytoplasmic Sperm Injection (ICSI) - Male Infertility Treatment
- ICSI means Intracytoplasmic Sperm Injection
- The technique was developed by Gianpiero Palermo at Brussels University.
- The first successful birth by ICSI took place 1992
What is ICSI ?
ICSI-IVF is a specialized form of in vitro fertilization that is used mostly commonly in cases of severe male infertility, after repeated failed fertilization attempts with conventional IVF, or after egg freezing (oocyte preservation).
Intracytoplasmic sperm injection is an In Vitro Fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg.
When is ICSI indicated?
- Male Infertility issues – low sperm count, motility, morphology (OATS)
- Azoospermia ( Testicular Sperms)
- Thick Zona (Egg Shell)
- Previous Fertilization Failure
What is the difference between IVF and ICSI?
- ICSI needs one only sperm cell per egg and is injected into the egg using the Micromanipulator machine.
- IVF utilizes 50,000 – 100,000 sperms when only one sperm naturally penetrates and fertilizes the egg.
How does a sperm normally fertilize an egg?
As they travel through the fallopian tubes, sperms gain the ability to fertilize an egg. They undergo two processes: capacitation, where its outer layer is changed, and hyperactivation, which changes the way the sperm’s tail moves .To enter the egg, the sperm has to break through a group of cells known as the cumulus oophorus that surround the egg. The sperm dissolves these cells using an enzyme ,acrosin. Once a sperm has penetrated an egg, this membrane changes, and becomes impenetrable to other sperm. It then fuses with the DNA of the egg to form the zygote.
How is the ICSI procedure done?
The ICSI procedure requires much attention and high concentration and is done by experienced embryologists with the help of the ICSI micromanipulator machine. It starts with the identification of patients: eggs and sperm. Then, in separate droplets, sperm cells and eggs are placed onto the same culture plate in the ICSI machine.The egg is stabilized by the larger needle and the sperm is injected by the smaller needle under the microscope with 400 times magnification.
What happens after the ICSI Procedure?
The embryos are formed after the ICSI procedure. They are cultured in the lab for 2-5 days. They are then transferred into the uterus.
How can we improve ICSI results?
- By choosing sperms with good DNA fragmentation index
- Double ejaculate in case of very poor motility
- Good sperm selection and ICSI technique by the embryologist
- Using optimal stimulation protocol and giving good quality eggs to the embryologists
- Good preparation techniques of the endometrium for pregnancy results
What is the incidence of congenital malformations with ICSI?
- The incidence of congenital malformations with natural conception is about 1-2%.
- The incidence of congenital malformations with ICSI is about 2-3%.
- Increases in those with extreme oligospermia and azoospermia
- Genetic Screening needs to be done in men with severe OATS and azoospermia
- PGS is needed in those who have a specific genetic defect
Is ICSI better than IVF ?
ICSI is indicated in those patients where there is male factor infertility and previous fertilization failure. It is not indicated in all IVF cases and it does not improve pregnancy outcome when used in non- indicated cases.
