What is Intracytoplasmic Sperm Injection (ICSI) And How Does It Help in Fertility Treatment?

If you’re thinking about fertility treatments, especially if you have male infertility, Intracytoplasmic Sperm Injection (ICSI) might be right for you. Used successfully worldwide in over 60–70% of IVF cycles, ICSI is among the most established and technically advanced methods available to alleviate any sperm-related issues by directly injecting a healthy sperm into a mature egg to achieve fertilization, even in the most challenging cases.

It is particularly indicated in patients with low sperm counts, poor sperm motility or if previous cycles of IVF have demonstrated poor fertilisation. By leapfrogging natural obstacles to conception, ICSI dramatically increases the odds that an embryo will be created , restoring hope for countless couples desperate to have a child.

What is ICSI?

I.C.S.I. (pronounced Ick-see): Known as intracytoplasmic sperm injection, a single live sperm is injected directly into the center of a human egg. The technique was developed to help couples who have not conceived after an unsuccessful IVF cycle or who have severe male factor infertility. Most of the barriers to fertilization are bypassed by the method, leading to the possibility for couples with a low chance of conceiving on their own to obtain a fertilized embryo.

In order to develop several mature eggs, the female partner receives ovarian stimulation with fertility drugs as part of the treatment. Once the eggs are aspirated vaginal ultrasound, the eggs are placed to carefully culture in the embryology lab in carefully maintained conditions. A sample of sperm is obtained by centrifuging, or spinning, the sperm cells through a particular medium. This strains out the majority of the dead sperm and debris from the live sperm. With a glass needle, the embryologist then injects the one remaining healthy sperm into the egg.

The process had previously been done only to the pronuclear stage in 1987. The first embryo to be activated by ICSI was produced in 1990, however the birth of a baby by ICSI did not occur until 14 January 1992 after the conception in April 1991.

How Does It Aid with Fertility Treatments?

ICSI has revolutionized the management of male infertility. Couples who have failed IVF a number of times, poor sperm parameters, or eggs that are difficult to fertilize may find new hope in ICSI. By having someone physically help fertilization along, you can select only strong sperm cells then directly insert them into the egg through ICSI, eliminating many of the obstacles to infertility. This strategy can be especially helpful when:

• There are few, or any, motile sperm in a semen specimen.
• The egg is not reachable by sperm in a normal way.
• Previous IVF cycles that have not resulted in fertilization
• Testicular or epididymal sperm extraction

ICSI results in very high fertilization rates. This means there are more viable embryos, increasing the chances of a successful embryo transfer and subsequently, pregnancy. ICSI also offers opportunities to benefit from preimplantation genetic testing (PGT), embryo freezing and vitrified oocyte cycles: all essential elements of personalized fertility management.

When is ICSI recommended?

ICSI is indicated in the following situations:

• Seed quality This procedure is good for men with problems on: • Sperm motility • Sperm count • Sperm morphology
• Men who have had a vasectomy
• Testicular biopsy sperm
• Samples of cryopreserved semen
• Low egg number
• Oocyte quality is poor/wall thick
• No fertilization in the prior cycle of traditional IVF.
• Microinjection of vitrified oocytes
• The embryo undergoes genetic or chromosomal testing

What are the potential threats of ICSI?

A small percentage of eggs ( approx. 5%) can be damaged by the needle during the ICSI procedure. This can also be taken to “0” with an experienced Embryologist. The mother’s age also plays a role in having a baby with a chromosome defect such as Down syndrome but not with ICSI.

How is ICSI carried out?

• Ovarian Stimulation: The ovaries produce one egg during a normal menstrual cycle. In IVF, medication is injected to stimulate growth of the follicles resulting in multiple eggs. Follicle development is tracked with ultrasound in the clinic. The stimulation phase stops when follicles are considered large enough.
• Follicular Puncture (Egg Pickup): Trigger shot is given (to cause the eggs to mature), 34-36 hours later, the egg retrieval is done. This is an outpatient procedure involving removing eggs from the ovaries transvaginaly under local or general anesthesia with the assistance of ultrasound.
• Oocyte Fertilization & Embryo Culture: On the day of egg retrieval, a semen sample is obtained and processed. Intracytoplasmic sperm injection (ICSI): ICSI is performed, where the embryologist will inject a single sperm into each egg. The method of fertilization is chosen by the doctor and embryologist that is best for the couple in order to maximize the success. Fertilization is examined at about 17 h after injection using this facility's purpose-built in vitro fertilization chambers with monitoring capabilities for the well-being of the embryos.
• Embryo Transfer: Embryo development is observed daily and the doctor and embryologist together decide when to do the embryo transfer for ensuring the best possible chance to become pregnant. The procedure is a painless and straightforward process, which is performed under ultrasound guidance by transferring the embryos into the uterus using a soft catheter with no requirement for sedation or anaesthetic. Bedrest after embryo transfer is not usually recommended.

How likely is ICSI to work?

By making it easier for the sperm to fertilize the egg, intracytoplasmic sperm injections, or ICSIs, can also help men with severe infertility. In cases where male factor or previous IVF fertilization failure exists as the infertility reason, ICSI increases the chance of successful pregnancy in those couples. The most remarkable progress in assisted reproductive technology is IVF with ICSI which makes it possible for couples where the man is infertile to father their children of theirs.