Intra Cyto Plasmic Sperm Injection

In normal conception a million or more sperm are mustered to fertilize one egg. In Intra Cyto Plasmic Sperm Injection (ICSI), a single sperm is injected into a single egg with the help of an instrument called the micromanipulator. Infertile couples with severe male factor infertility (poor sperm count, motility, or morphology) can be treated with Intra Cyto Plasmic Sperm Injection. Now, even azoospermic men with no sperm in their ejaculate, have a chance to father a biological child. ICSI is a safe, high tech but simple procedure, performed world wide with good success rates.

Indications:

1. Couples with severe male factor infertility who do not want donor sperm insemination.
• Sperm concentrations of less than 15- 20 million per ml
  OR
• Sperm motility less than 35%
  OR
• Very poor sperm morphology
2. Couples having IVF who have had a previous cycle with no fertilization – or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
3. All couples having IVF who have a very low yield of eggs at the egg retrieval. In this scenario, ICSI is used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs.

Procedure:

The woman goes through a typical ovarian stimulation protocol during which fertility drugs are administered to the female partner to aid in the production of multiple eggs. The eggs are then surgically removed as in oocyte retrieval. For ICSI, sperms can be obtained either from the ejaculate or by any kind of sperm retrieval techniques. In case it is not possible to obtain sperms by this method, sperms can be recovered from the testes by means of a small surgical procedure. These procedures can be carried out under local or general anesthesia, and are as follows.

Retrieval of Sperms :

• Micro Epididymal Sperm Aspiration (MESA), a delicate surgical technique using the microscope to aspirate sperm from the epididymal region.
• Percutaneous Epididymal Sperm Aspiration (PESA), in which a small needle and a local anesthetic are used to aspirate sperm from the epididymis.
• Testicular Sperm Biopsy (TESE), in which a small biopsy of testicular tissue is taken under anesthesia. TESE is the ultimate option when no sperm are obtained with MESA or PESA.

These procedures are done on an outpatient basis.

Sperm obtained by ejaculation, or through MESA, PESA, TESE must be processed well before the ICSI procedure is carried out. The selected sperm is injected into the mature eggs retrieved from the woman, checked for fertilization, allowed to grow in the lab for about three to five days and then on day three or day five of egg retrieval, selected embryos are replaced in to the uterus. Sperm may also be retrieved ahead of time and frozen for future use.

How is ICSI performed?

1. The mature egg is held with a specialized holding pipette.
2. A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.
3. This needle is then carefully inserted through the zona (shell of egg) and into the cytoplasm of the egg.
4. The sperm is injected into the cytoplasm and the needle carefully removed.
5. Injected oocytes are released from the holding pipette, washed and transferred to a small drop of fresh medium.
6. After injection of the sperm, the eggs are incubated for 16- 18 hours, then examined for fertilization.
7. The resulting undamaged embryos are then either transferred back to the woman’s uterus, using standard IVF techniques, or can be frozen for transfer at a later time.

Fertilization and pregnancy rates with ICSI:

Generally fertilization rates are more in ICSI procedure, when compared to conventional IVF (60-85%). Pregnancy rates for in vitro fertilization procedures with ICSI are higher than conventional IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile with good egg quality as compared to some of the women having IVF for reasons other than male factor infertility.

Pregnancy & delivery are expected to proceed as normal. No complications in terms of abortions, congenital abnormalities or pregnancy complications result due to the ICSI procedure per se.

This is some background information about the procedure. If you have any further queries please approach the front desk to schedule an appointment with one of our doctors. We would be happy to be of assistance.