ICSI stands for Intracytoplasmic Sperm Injection and is a specialization in In Vitro Fertilization. In couples where there is severe male infertility and is unable to conceive even after repeated fertilization attempts by conventional IVF treatment or after egg freezing (oocyte preservation), ICSI is the next step in fertility treatment. If a man does not have any sperm in his ejaculate, but he is producing sperm in his testis, these produced sperms are retrieved through a surgical step called testicular sperm extraction (TESE). Sperm retrieved through TESE require the utilization of ICSI as they are not capable of fertilizing on their own. ICSI is also the method of choice in cases of retrograde ejaculation, where the sperm retrieval is from the urine.
However, severe male infertility is not the only cause, where ICSI-IVF has opted. Other reasons where ICSI is the choice are:
• Previous IVF cycle had no or few fertilized eggs: In some cases, with a good number of eggs retrieval and healthy sperm count, but still, no eggs get fertilized. In such cases during the next IVF cycle, ICSI is tried.
• Frozen sperm is being used: If the thawed sperm appear to be inactive, ICSI-IVF is on a recommendation.
• Frozen oocytes are being used: Verification of eggs can cause hardening of eggshell, which causes complication in fertilization. IVF with ICSI can help in overcoming this hurdle.
• PGD is being done: PGD (Preimplantation Genetic Diagnosis) is an IVF technique that allows genetic screening of embryos. Here ICSI is essential for the embryo biopsy
• IVM (In Vitro Maturation) has opted: IVM is an IVF technology where eggs are retrieved from the ovaries before they are completely mature. They go through the ultimate stages of maturation within the lab. Some research has found that the rate of fertilization of IVM eggs by sperm cells is lower when compared to fertilization through traditional IVF. But IVF with ICSI can be the only option in some select cases.
Who can opt for ICSI?
• Couples who want to include PGT in their cycles to ensure fertilization is better.
• Couples who are facing severe male infertility
• When the only course of action is by sperm retrieval through TESE/MESA
• Poor oocyte quality/ low oocyte yield
• Suitable for women aged over 40 years of age ( to overcome sperm-Oocyte Penetration Issues)
• Couples who are facing repeated fertilization failure
• Ejaculatory Dysfunction
The procedure involved in IVF-ICSI:
- As with regular IVF procedure, ovarian stimulation drugs are given.
- Fertility Doctor monitors the progress with blood tests and ultrasounds.
- Once enough good-sized follicles are produced, egg retrieval will be done, from the ovaries with a specialized ultrasound-guided needle.
- The partner provides sperm samples the same day(unless you are using a sperm donor or previously frozen sperm)
- Once the eggs are retrieved, an embryologist places the eggs in a specific culture medium.
- Using a microscope and tiny needle, the embryologist injects a single sperm into the egg cytoplasm. The process will be for each egg retrieved.
- These injected eggs are then cultured in the lab, under ideal conditions, to allow the fertilized eggs to grow and divide.
- If fertilization takes place and if the embryos are healthy, they will be transferred into the female uterus via a catheter placed through the cervix, two to five days after the retrieval.
Risks involved with ICSI:
- Even though the fertilization rates of IVF with ICSI can be as high as 50 to 80 per cent, not all fertilized eggs will develop into healthy embryos. A few or many of the eggs may be abnormal, depending on the age of the women. Fertilization may result in abnormal embryos in some cases. Occasionally, eggs may get damaged in the procedure. There is also a theoretical study that says ICSI allows less healthy sperm to fertilize an egg, which may result in defective embryos which may not develop and grow. These sperm would never have been able to fertilize an egg naturally.
- The risk of defective birth in children conceived naturally is same as of with children conceived with IVF and ICSI. The risk of an ICSI-conceived child having defects is low, less than one per cent. While, earlier studies found some specific risks of defective birth, which may be due to lower quality sperm (sex chromosome abnormalities, defects in the urinary system or genitals, and other rare syndromes), more recent studies have found that the chance of this happening appears to be almost non-existent.
- Another risk of ICSI is a risk of the greater chance of multiple births than through natural conception. By carefully controlling the number of embryos transferred to the female partner’s uterus, this risk can be minimized. Multiple births as twins or more, may carry a higher risk of complications to both the mother and the babies. However, cases of triplets or more are extremely rare.
If your fertility specialist doctor recommends ICSI, find out the reason for the same, and evaluate the risks and benefits. IVF with ICSI makes it possible for thousands of couples around the world to have a baby when the conditions are not conducive to natural conception. Consult a good fertility doctor and find out whether it’s the right treatment for you and your partner.
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