INTRA CYTOPLASMIC SPERM INJECTION (ICSI)

This sophisticated technique was developed by Gianpiero Palamo around 1991 at the Vrije University, Brussel in the Center for Reproductive Medicine headed by Paul Devroey and Andre Van Steirteghem.

What is ICSI Treatment?

Intra Cytoplasmic Sperm Injection (ICSI) involves the insertion of a single spermatozoon into the oocyte, bypassing all the egg coat penetration and gamete fusion steps characteristic of natural fusion.

  • It is most commonly used to overcome male infertility problems, such as low sperm counts (oligozoospermia), low sperm motility (asthenozoospermia) or abnormal-shaped sperm (teratozoospermia) or MESA or TESA.
  • Obstruction of the male reproductive tract resulting in absent sperms in the semen (obstructive azoospermia). Sperms can be retrieved in such cases from epididymis by PESA (Percutaneous Epididymal Sperm Aspiration). TESA is preferred as testicular sperm can be frozen at same time for subsequent use.
  • Cases of non obstructive azoospermia –sperms can be found in 60% of these men.
  • Prior failure with conventional insemination in IVF.
  • Less no. or poor quality oocytes of the female.
  • If Pre-implantation Genetic Testing (PGT) is required.
  • Fertilization after in-vitro Maturation (IVM) of oocytes.
  • Fertilization of cryo-preserved oocytes.
  • Advanced maternal age.
For whom is it done?

If conventional insemination is used, there might be contamination of DNA from other sperms which might be adherent to the zona. ICSI also enhances the number of fertilizable oocytes and so embryos available for screening.

What is the Procedure of ICSI Treatment?
  • As with standard IVF treatment, the female partner will be given fertility drugs to stimulate ovaries to develop several mature eggs for fertilization.
  • The male partner may produce a sperm sample himself by ejaculating into a container on the same day of eggs collection. If there is no sperm in semen, doctors can extract sperm from him under local anaesthetic. Doctor will use a fine needle to take the sperm from his epididymis, in a procedure known as percutaneous epididymal sperm aspiration (PESA), or from testicle, in a procedure known as testicular sperm aspiration (TESA).
  • If these techniques get failed to remove enough sperm, then another technique may be tried. The doctor will take a biopsy of testicular tissue. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is carried out with a microscope. TESE is sometimes carried out before the treatment cycle begins, and under local anaesthetic. The retrieved sperm are frozen. Any discomfort felt by patient should be mild and can be treated with painkillers.
  • After giving a general anaesthetic for short time, the doctor will remove eggs from the female patient using a fine, hollow needle under ultrasound guidance.
  • The embryologist then isolates individual sperm from the male partner in the lab and injects them into the individual eggs of the female. This whole procedure is carried out using special needles and under high power (20x-40x) inverted microscope. Two days later the fertilised eggs become balls of cells (Blastomere) called embryos.
  • The doctor transplants one, two or maximum three embryos into the uterus through cervix using a thin catheter.
  • Embryos may be transferred two to three days after fertilisation, or five days after fertilisation. Five days after fertilisation the embryo will be at the blastocyst stage. If the patient demands for just having one embryo transferred (called elective single embryo transfer, or eSET), having a blastocyst transfer can improve the chances of a successful, healthy, single baby.
  • If all steps go well, an embryo will attach to the uterus wall and continue to grow to become a baby of your own. After about two weeks, the patient is advised to take a pregnancy test.
What are the risk factors in ICSI Fertility Treatment ?
  • As with standard IVF treatment, the female partner will be given fertility drugs to stimulate ovaries to develop several mature eggs for fertilization.
  • Certain genetic and developmental defects may occur in a very small number of children born using this treatment. However, problems that have been linked with ICSI may have been caused by the underlying infertility, rather than the technique itself.
  • An increased risk of miscarriage because the technique uses sperm that would not otherwise have been able to fertilise an egg.
  • A low sperm count caused by genetic problems could be passed on to a male child, so it is advisable to undergo genetic tests before going ahead with ICSI.
  • Infertile men with low sperm count or no sperm in their ejaculate may be tested for cystic fibrosis genes and for chromosome abnormalities.
What are the Success rates in ICSI Fertility Treatment ?

ICSI success rates are very similar to in vitro fertilisation (IVF) rates. According to 2010 NICE figure, women having in vitro fertilisation (IVF) using fresh embryos created with their own fresh eggs, the percentage of cycles started that resulted in a live birth is around 35% but age is the most important prognostic criteria.

Summary
  • ICSI is a safe and effective therapy for the treatment of male factor infertility.
  • ICSI can increase fertilization rates when lower than expected or failed fertilization has previously occurred with conventional insemination.
  • ICSI may be of benefit for patients undergoing IVF with PGT, in-vitro matured oocytes and previously cryopreserved oocytes.