03 Aug Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection (ICSI) is a type of in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. After fertilization has taken place, the egg is transformed into a proembryo and transferred to the uterus where it continues its development.
ICSI is applied primarily to alleviate problems of severe male infertility, with too few motile and morphologically normal sperm.
- Very low sperm count
- Immotile or abnormal sperm
- Artificially extracted sperm (from urine, testis or epididymis)
- High levels of antibodies in the semen
- Previous fertilization failures using conventional IVF.
Before ICSI, the female partner undergoes stimulation of the ovaries to encourage development and maturation of the eggs. This is followed by transvaginal retrieval of the eggs. A specialized pipette is used to handle the mature egg. The male partner/donor provides a sperm sample on the same day when the eggs are collected. A specialized hollow needle is used to immobilize and pick up a single sperm. If the sample has no visible sperm, then it may be extracted directly from the epididymis (percutaneous epididymal sperm aspiration) or testicle (testicular sperm aspiration).
The needle is then carefully inserted into the cytoplasm of the egg and the sperm is injected. The eggs are checked the next day to look for normal fertilization. If present, the embryos are transferred back into the uterus. The maximum number of embryos that can be transferred in the uterus is two. For suitable candidates above 40, an elective single embryo transfer (eSET) may be considered in the first and second cycles. Once transferred,e a blood test or ultrasound is done to determine if implantation and pregnancy have occurred.
Chances of success are variable, but the age of the woman is an important factor. Typically, about 25% of patients will have conceived after the first attempt at ICSI.
Advantages of ICSI:
ICSI may give couples a chance of conceiving when other fertility treatments options have failed. If the male partner is unable to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI. Also, ICSI may be useful in unexplained infertility.
Disadvantages & Complications of ICSI:
ICSI is a more expensive procedure as compared to IVF.
Furthermore, there is less amount of experience with ICSI as it is a relatively newer procedure as compared to IVF.
There is an increased risk for some birth defects in children conceived with the aid of ICSI, such as imprinting defects. It may occur due to manipulation of either gametes or zygotes during ICSI. There may have a higher risk hypospadias in baby boys.
Studies suggest that complications, such as multiple gestations, preterm labor, and other perinatal complications are more common in pregnancies associated with ICSI.
Overall, despite its potential complications, ICSI can be a viable means of conceiving when all other options seem to fail, and the process, while quite involved, can bear fruit for the couple.