INTRACYTOPLASMIC SPERM INJECTION (ICSI)
Assisted reproductive technologies (ART) is a lab-based treatment that fertilises sperm and eggs outside of the human body for conception. In the last 50 years, IVF technology is by far the most common ART procedure performed along with intracytoplasmic sperm injection. Both ICSI and IVF are used to treat infertility. ICSI has been shown to improve fertilisation rates for patients with male factor infertility or past conception failures. ICSI treatment is a procedure that directly injects a sperm into the oocyte, through the cytoplasm.
About Intracytoplasmic Sperm Injection (ICSI)
This is a specialised type of assisted reproductive technology procedure known as Intracytoplasmic sperm injection (ICSI). ICSI is performed with the help of a technique known as micromanipulation. This involves the use of very fine surgical tools and a high-powered microscope. During the procedure, a sperm is placed into a woman's egg with a needle in a clinical or a lab setting. A sperm cell is directly injected into the egg or oocyte's cytoplasm to develop an embryo or a fertilised egg. The procedure is a type of IVF treatment.
Usually, doctors use the ICSI treatment along with IVF and the next day, the doctor checks to see if the egg is fertilised. The fertilised eggs are observed carefully as they develop over the following days until they become embryos with multiple cells. These embryos are then placed into the woman's uterus by the doctor.
When Is ICSI Performed?
Intracytoplasmic sperm injection is the most common and successful treatment for male infertility. ICSI is recommended in the following cases when:
- Men have an extremely poor sperm count much lower than 20, 000,000 sperm per millilitre of ejaculate
- Men are experiencing issues with sperm motility (sperm movement)
- Men are facing problems with sperm development
- Men have a high incidence of antisperm antibodies that attack and damage sperm in their semen
- Poor quality and quantity of sperm in the frozen sperm sample
- Men have blockages that prevent sperm from being ejaculated, like after a vasectomy
- Couples are aiming to increase the number of high-quality embryos obtained from a single egg retrieval
ICSI Process
When in vitro fertilisation (IVF) is used with intracytoplasmic sperm injection, the procedure allows otherwise sterile couples to become parents. ICSI treatment follows these steps:
Ovarian Stimulation
As with regular IVF, the woman will first need to take fertility medication to stimulate the production of eggs in the ovaries. During this time, the doctor will monitor the development of the eggs. The ICSI procedure is performed when the egg is ready to be retrieved. Medications are used to stimulate the ovaries for about 8 to 14 days to produce many mature eggs, increasing the chances of success.
Retrieval of sperm and eggs
During this stage, a doctor performs the procedure to collect eggs from the ovaries. The eggs are combined with the collected sperm for fertilisation.
The man will have to produce a sperm sample ejaculating into a cup, or the sperm will have to be surgically retrieved. There are a number of different ways the sperm may be retrieved. In some cases, the sperm retrieval procedure may be performed earlier, and the sperm may be frozen.
Fertilisation
Once retrieved the semen sample is washed and a single sperm is isolated. This is then injected into an egg with a very fine hollow needle. The embryologist injects the best quality sperm into each mature egg under a microscope.
Since the sperm is injected directly, it bypasses the need to swim through the cervical fluid. It can take a sperm up to 24 hours to fertilise an egg and create an embryo.
Benefits of ICSI Treatment
The primary advantage of the ART treatment like intracytoplasmic sperm injection during IVF (IVF ICSI) is an enhanced fertilisation rate, which can increase the number of fertilised eggs available for transfer or freezing. For couples struggling with male factor infertility, ICSI treatment can boost your chances for a successful fertilisation under standard insemination such as IUI. ICSI is effective for those looking to increase their high-quality embryos created from one egg retrieval. Men who don't have issues with sperm development, sperm count, or sperm motility can still benefit from ICSI. Also, couples with failed previous IVF attempts may benefit from ICSI treatment. Additionally, couples who want to test for certain genetic problems often make good candidates for ICSI treatment.
Potential Side Effects of ICSI
Like any other surgical process, ICSI also has some risks associated with it. Some of the potential issues that could arise are:
- The egg may be damaged
- The embryo may not grow and develop after fertilisation
- In rare cases, it may lead to genetic defects.Most birth defects are due to the poor quality of sperm and NOT due to the procedure of ICSI. Most of these are minor defects of urogenital system which can be surgically corrected post birth of the child.
- Your fertility doctor should be able to guide and prepare you through the process.
How do you prepare for ICSI Treatment
Before ICSI treatment can begin, the fertility team collects the sperm and eggs. The egg retrieval process entails ovulation induction, where medication injections stimulate the ovaries, which results in mature eggs. At this stage, Transvaginal ultrasound technology is used to guide a needle into the ovaries to collect the eggs, with mild anaesthesia to ensure that the patient is comfortable. Also, the sperm collected is analysed for mobility, volume, and quality. In certain cases, procedures like microscopic testicular sperm extraction or electroejaculation may be necessary, and the sperm can be frozen and stored for future use in IVF.
How much does ICSI cost?
The price of ICSI fertility treatment typically starts at Rs 1,50,000, but it may vary depending on the fertility hospital you choose. In general, ICSI treatment in tier I cities is more expensive than in tier II and III cities for infertility treatment.
Frequently Asked Questions
1. How does ICSI help you with male infertility?
ICSI intracytoplasmic sperm injection is designed to address male infertility issues. It involves injecting a sperm directly into an egg, increasing the chances of successful fertilisation. If you have reduced sperm motility, low sperm count, or abnormal sperm morphology, ICSI fertility can significantly improve the likelihood of achieving pregnancy.
2. Is ICSI a suitable option for you if previous IVF attempts failed?
Yes, if previous IVF attempts did not result in successful fertilisation, ICSI IVF can be an effective alternative. By directly injecting a sperm into the egg, ICSI infertility treatment overcomes certain barriers encountered in standard IVF, providing you with a better chance of achieving pregnancy.
3. What can you expect during the ICSI procedure?
During the ICSI infertility treatment, you can expect a process similar to IVF, including ovarian stimulation, egg retrieval, and embryo transfer. However, in ICSI, an embryologist will carefully select a healthy sperm and inject it directly into each mature egg. Your fertility specialist will guide you through the entire process and explain any specific instructions or considerations relevant to your unique case.
