ICSI Treatment (Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection (ICSI) is performed as part of your in vitro fertilization (IVF) procedure. It is a process in which a single sperm is injected into the cytoplasm (center) of each egg by an embryologist. After the egg has been injected with sperm, the embryologist will observe the egg over the next day or so. If fertilization occurs and the embryo matures properly, it will be transferred into your uterine cavity.
The success rate of ICSI is significantly higher than IVF and the couples often opt for ICSI when the conventional IVF technique does not produce desired results for them. The success rate of ICSI is directly proportional to the age: the younger the patient is; the higher are the chances of success.
Intracytoplasmic Sperm Injection (ICSI) can be used as part of an in vitro fertilization (IVF) treatment to help you and your partner conceive a child. ICSI is the most effective form of treatment for infertile men and is used in almost half of IVF treatments.
ICSI only needs a sperm, which is injected directly into the egg. The fertilized egg (embryo) is then transferred to the uterus. During ICSI, the sperm does not have to move to the egg or enter its outer layers. This means that it can help couples where the sperm of the man:
Can not get to the egg at all or can happen to the egg, but for some reason can not fertilize it.
Who could be recommended to have ICSI?
ICSI-IVF is recommended for couples who have had low or no fertilization during standard IVF, as well as for men who have:
This implies that the sperm is injected directly into the egg. Some men may need their sperm removed surgically first.
If you have tried IVF, you can switch to ICSI if you can not get enough eggs or if the recovered eggs are not fertilized with IVF.
Although ICSI can improve the chances of fertilization compared to IVF, this does not guarantee that fertilization will occur.
How does ICSI work?
As with standard IVF treatment, fertility drugs will be needed to stimulate the ovaries to develop several mature eggs for fertilization. Doctor will use ultrasound, and sometimes blood tests, to monitor this stage of your treatment. When your eggs are ready for collection, you and your partner will follow separate procedures.
Your partner will be asked to produce a sperm sample himself by ejaculating in a cup the same day that your eggs are collected.
If there is no sperm in his sperm or if he is unable to ejaculate, doctor may be able to extract the sperm. For this procedure, doctor will use a thin needle to take sperm from your partner: epididymis, as part of a procedure called percutaneous epididymal sperm aspiration (PESA), or testicle, in a procedure called testicular sperm aspiration (TESA). This will usually be done under local anesthesia so that your partner feels no pain.
If these techniques do not eliminate enough sperm, your doctor may do a testicular tissue biopsy, to which a sperm is sometimes attached. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is performed with a microscope. This will usually be done under general anesthesia.
For practical reasons, surgical removal of sperm from the epididymis or testis is often done before the start of the treatment cycle. The recovered spermatozoa are frozen. Any discomfort felt by your partner should be mild and can be treated with painkillers.
During egg retrieval, you may be sedated but conscious. The doctor will remove your eggs with a thin, hollow needle attached to an ultrasound probe. You will receive progesterone in the form of a pessary or an injection of progesterone gel to help the lining of your belly prepare for the transfer of the egg. You may feel a little hurt and painful after recovering the egg and have slight bleeding.
Meanwhile, an embryologist isolates individual sperm cells in the lab and injects them into your individual eggs. A day later, the fertilized eggs will become embryos. The procedure then follows the same steps as IVF. Doctor will transfer one or two embryos into your uterus, through the cervix, using a thin catheter (tube) usually guided by ultrasound.
Embryos can stay in the lab for up to six days, but can be transferred two to three days after fertilization or five days after fertilization. If transferred to five days, the embryo will be in the blastocyst stage. If a single embryo is transferred (called a simple elective embryo transfer or eSET), a blastocyst transfer can increase your chances of success, from a healthy single baby.
The maximum number of embryos that can be transferred to your belly is two. If you are under 40 years of age and you are an appropriate candidate, you may be recommended for elective single embryo transfer (eSET) during your first and second cycles. If you have one or more high quality embryos, eSET can increase your chances of having only one healthy baby over time.
If you are 40 years old or older, two embryos transferred per cycle could be offered to you, because your chances of conceiving with your own eggs are less great. If the eggs are donated, only one or two can be transferred depending on the age of the donor and the quality of the embryos.
Whatever your age, if you have a high quality blastocyst, it can be transferred alone, as it is your best chance of a healthy pregnancy. Very good embryos, if any, can be frozen if this cycle fails or to have another baby in the future.
If all goes well, an embryo will attach to the wall of your uterus and continue to grow to become your baby. After about two weeks, you will be able to take a pregnancy test.
How long does ICSI treatment take?
An ICSI cycle takes between four and six weeks. You and your partner can expect to spend half a day at the clinic for egg and sperm retrieval procedures. You will usually be asked to come back between two and five days later for the embryo transfer procedure.
If you are under 40, you should be eligible for three complete IVF cycles with or without ICSI. If you are between 40 and 42 years old, have never had IVF, and have no evidence of low egg counts, you should complete a full cycle after a thorough discussion of the implications of IVF and pregnancy at this age.
What are the benefits of ICSI?
ICSI can give you and your partner a chance to conceive your genetic child if it is unlikely that other fertility treatments can do so.
If your partner is unable to ejaculate the day of egg collection for standard IVF, sperm can be extracted for ICSI. ICSI can also be used to help some couples with unexplained infertility. In this case, your doctor will probably initially recommend a standard IVF because the ICSI and IVF pregnancy rates are very similar and IVF is a less complex treatment.
ICSI does not seem to have any effect on the mental or physical development of your child.
I had ICSI and it did not work - and after?
As with IVF, many experts recommend waiting a few months after treatment before trying again. This gives you a break from the stress of the treatment and a chance for your body to recover. If you wish, you can try ICSI again if your doctor thinks you have a reasonable chance of success.
Alternatively, you can think about your options and decide whether to continue treatment or explore other options for starting a family, such as using a donor's sperm or adoption.
What is the success rate for ICSI-IVF?
The ICSI procedure fertilizes 50 to 80% of the eggs. You can assume that all eggs are fertilized with ICSI-IVF, but this is not the case. Fertilization is not guaranteed even when a sperm is injected into the egg.
Remember that fertilization rates do not tell you the clinical pregnancy rate or the live birth rate. It all depends on your fertility problem and your age. The younger and healthier you are, the healthier your eggs are and the more likely you are to have a healthy pregnancy.
Once fertilization has occurred, the success rate of a couple using ICSI with IVF is identical to that of a couple using regular IVF treatment.