Intracytoplasmic Sperm Injection (ICSI)
Typically it is used in case of low sperm count, poor sperm
movement and even if when sperm are absent in ejaculate, it can be extracted
from testis (testicular sperm extraction). With ICSI, the embryologist takes a
single sperm and injects it directly into an egg.
The objective is being to increase the chances of fertilization
and development of embryos used in conjunction with IVF. The treatment steps
are similar to IVF except the step of fertilization, and may also be done if
regular IVF treatment cycles have not achieved fertilization.
How ICSI is done in our
fertility clinic?
As in IVF procedure, eggs are surgically removed which are
normally surrounded by cluster of cells called cumulus corona cells, which
needs to be removed before the sperm injection process takes place. Removal of
these cells gives a clear insight of the eggs to an embryologist to access the
maturity of the egg.
On the other hand, male partner need to provide his sperm sample
(either retrieved surgically from testis or by masturbation) for the procedure.
Fresh eggs are then placed in a dish under 200 or 400 magnification with an
inverted microscope fitted with micromanipulator. The egg which is around 100
micron in width and is held by a glass holding pipette with a diameter of 40 to
50 micron usually on the left side. Sperms are first immobilized with chemical
(PVP) and by hitting on the tail, loaded in the injection pipette.
Injection is done with very fine movements of micromanipulator and
usually it is completed within a minute. After 16-18 hours of injection,
fertilization is checked and it is the skill of embryologist which matters the
most in whole procedure. Result: The fertilization rate with ICSI is around 85%
(we should not expect 100% fusion of both the gametes, even though sperms are
injected inside the eggs by us.
Who requires ICSI?
Patient who have low sperm count, very poor motility or a high
percentage (greater than 95% of sperm with "abnormal" shape
(morphology).
ICSI is the only hope for
the patient-
- Who do not ejaculate any sperm (cryptozoospermia).
- Who for various reasons have problems obtaining an erection and ejaculation?
- Men with spinal cord injuries, Hodgkin's, diabetes and other medical problem.
- Men with obstructive azoospermia, congenital absence of the vas-deferens.
- Patient who have low sperm count, very poor motility or a high percentage (greater than 95%) of sperm with "abnormal" shape (morphology).
Steps involved in ICSI
- Women is stimulated for follicle production and egg recovery as in IVF.
- Single sperm is selected from the semen or directly from the testis/epididymis by TESA/PESA.
- This single sperm is injected into cytoplasm of egg and are left for fertilization in an incubator as in IVF
- Transfer of embryo to the uterus occurs in the same routine manner as that for IVF. ICSI can be used for all types of sperm problems-even those with extreme condition.
Chances of success
The success rate of IVF-ICSI treatment in our centre & other best centres all over the world is about 35-40%
