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IVF - In vitro fertilization
Intra- cytoplasmic sperm injection (ICSI)
Intra Uterine Insemination (IUI)

Intra- cytoplasmic sperm injection (ICSI)

Intra- cytoplasmic sperm injection (ICSI) is a technique for the treatment of extreme male infertility in which sperm are injected directly into the body (cytoplasm) of the egg. With ICSI we might need no more sperm cells than we have egg cells. The sperm we use frequently appear normal, but with ICSI we can also make use of immature or poor-swimming sperm.

When is ICSI Used ?

If there are even a small number of sperm in the ejaculate, (or if sperm are affected severely by antisperm antibodies during their maturation process) sperm can be taken from a semen sample for ICSI. If there are no sperm in the ejaculate, due to an obstruction or to very low sperm production, sperm can now be surgically retrieved directly from the testes or the epididymis (TESE, PESA). Because it is the genetic information carried in the head of the sperm that needs to get into the egg, immature sperm whose tails have not fully developed are adequate for use in ICSI. ICSI is also sometimes used if there is an apparent problem with fertilization in an IVF cycle.

How is it done?

This procedure is very specialized, and requires a great deal of skill on the part of the scientist. All the procedures require the use of special microscopes and micromanipulation equipment. To put it in perspective, an egg is approximately one-tenth of a millimetre across! The egg is gently held with a suction pipette (on the left in the picture below) while a sperm is picked up with a microinjection needle, and deposited in the cytoplasm of the egg. By doing this, several barriers to the sperm have been removed, and fertilization usually follows. The day after injection, we can tell whether fertilization has taken place if there are two small spheres (pronuclei) visible in the egg. If fertilization is successful, the pre-embryo (zygote) is allowed to divide several times in culture medium in the laboratory, before it is transferred to the uterus or fallopian tube. Any "spare" good embryos resulting from the procedure can be frozen for more attempts later. To summarize the ICSI process:

    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 in to the cytoplasm of the egg.
    4. The sperm is injected in to the cytoplasm and the needle carefully removed.
      The eggs are checked the next morning for evidence of normal fertilization

What is the success rate like?

ICSI has similar success rate to IVF (about 32% of embryo transfer procedures produce a clinical pregnancy). IVF has a slightly higher pregnancy (about 36%), although this might be explained by the problems inherent in some cases to the sperm generally used in ICSI procedures. Frozen embryo transfers after ICSI also have a similar success rate to those after IVF (about 29%). These results do vary with female age, with a substantial fall in pregnancy rates in women over the age of 38.

What else should you know about ICSI?

Patients should realise that there is a possibility that the same sperm problems the father has could be inherited by his sons. Also, men whose infertility is caused by a congenital blockage of the epididymis or absence of the vas deferens might carry one or more genes for cystic fibrosis. This is a very serious disease affecting the lungs and pancreas, and genetic screening of the prospective parents is strongly recommended. The embryos can be genetically screened before transfer by preimplantation genetic diagnosis (PGD) or tests can be performed during pregnancy (prenatal testing by amniocentesis or chorionic villus sampling). There is also an extra (thoug0h slight) chance that a child conceived with ICSI could have a chromosome anomaly. This can also be detected by PGD or pre-natal testing.



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