Modern medical practices include strategies for patients who cannot get pregnant on their own. IVF or in-vitro fertilization is the most popular method for this, and there is more to it. ICSI or Intracytoplasmic Sperm Injection is one of its two main procedures and not an alternate plan to the IVF method.
While its popularity is not the highest, its success rate is a good reason why this is rising. In IVF generally, the process of fertilization happens inside a laboratory, with the sperms penetrating the egg to fertilize it. While the conventional IVF method occurs in a petri dish, ICSI is more specified with the doctors selecting one sperm. They fertilize the egg using this and then insert the embryo in the uterine lining of the female.
Relation of IVF and ICSI
The relation between regular IVF and ICSI is that both work together to allow the female to get pregnant. Specialists give fertility stimulation medicines to the female patient. This allows them to produce eggs better, and the embryologist sees which are mature among them.
Subsequently, they harvest the mature ones and keep them in an incubator in the laboratory, during a small surgical procedure.
The sperm of the male partner gets stored on that day, too, or were previously frozen. The specialists check the specimens in the sample and find the motile sperms among them. And they use it in the actual procedure.
In terms of the convention IVF method, around 50,000 sperms are placed in the Petri dishes with each egg. And they naturally infiltrate the egg, each viable sperm racing to enter the cytoplasm. Nevertheless, there are some cases where the sperms cannot do so in the proper way, for various reasons. This is when the doctors implement the ICSI technique. The embryologist injects the egg with the sperm and allows the fertilization to occur.
Additionally, sometimes the sperm sample is borderline rather than completely motile or immotile. In this case, the doctor chooses a few of the sperms to use through the ICSI manner, and others are placed in the dish.
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Process of IVF with ICSI
The process of ICSI with the IVF treatment is very similar to the traditional IVF plan in the beginning stages. The doctors would prescribe drugs for ovarian stimulation in the first step. Then, they would run ultrasounds and blood tests to see how the drugs are progressing with the patient. If there are many good-sized follicles, the doctors would retrieve the eggs. They would use a specialized needle for this, which is ultrasound-guided.
The male partner would either give their sperm sample on the same day as the retrieval. Or, the doctors would use a sperm that was frozen beforehand, from the partner or a sperm donor.
After the retrieval, the embryologist would place the mature eggs inside a monitored culture. Thereafter, they would use a tiny needle and microscope to select one fertile sperm. They would insert that into the mature egg. If you have more mature eggs and there are many motile sperms, the process would repeat on each of them.
After this, the eggs would fertilize when the egg and the sperm merge successfully. The doctors would check if the embryos are in good condition for 3 to 5 days. Afterward, they would transfer one or two of them into the uterus. They would do so using a catheter and through the uterine cervix. Thereafter, the female patient would have a successful reproduction.
Medical conditions that need ICSI
To be specific, patients need the ICSI-IVF procedure mainly when the male partner is infertile. The main conditions that fall under this are:
- Teratozoospermia (unnatural shape of the sperm)
- Oligospermia (sperm count is abnormally low)
- Asthenozoospermia (the sperm does not move properly)
- Similarly, there are situations where the male patient does produce sperm, but not in his ejaculation. Hereby, doctors would use the TESE (testicular sperm extraction) method to retrieve the sperm. In this case, ICSI is a good partner for a successful pregnancy.
- Plus, if a person has retrograde ejaculation, ICSI is a helpful procedure. In this condition, the sperm is visible in the urine of the men.
Uses of the procedure
Doctors use ICSI with IVF for the following situations too.
- Use of frozen sperm – Sometimes, embryologists use frozen sperm to fertilize an egg during IVF. However, after thawing, the sperm may not look too active. Here, ICSI is a good choice.
- The first IVF cycles lack fertilized eggs– During IVF, in some cases, many eggs are retrieved and the sperm count is good too. However, further tests show that they did not fertilize any of the eggs or more of them. If this occurs for one or more IVF cycles, doctors would opt for ICSI treatment.
- For frozen oocytes – After vitrification, the shell of the eggs can harden too much occasionally. In this situation, the fertilization would not occur properly. Doctors would prescribe ICSI with IVF for this.
- With the IVM plan– One interesting IVF technology is IVM or in-vitro maturation. In this, before the eggs mature in the ovaries, they are retrieved. The entire maturation process occurs in the controlled environment of the laboratory. However, they do not always fertilize with the sperm cells as quickly as the regular IVF treatment. Here, pairing it with ICIS may work, but this requires more research for verification.
- During the PGD method – During IVF treatment, doctors can genetically screen the embryos using the PGD technology. However, during the normal fertilization period, many of the weak sperm may stay near the embryo. As a result, the outcome of the pre-implantation genetic diagnosis would not appear accurately. In this case, using the ICSI procedure would help immensely.
Does ICSI improve IVF success?
Many people have this idea that using ICSI is the ultimate guarantee for a successful IVF process. However, that is not the case.
Certainly, using ICSI improves the possibility of fertilization by a lot, but there is no guarantee to it. The success rate of fertilization occurs in around 50% to 80% of the eggs it is used on.
In the case of unsuccessful fertilization, the following are the more common reasons behind it.
- If the eggs mature before ICSI, they would not survive after getting injected with sperm. Plus, the egg quality itself may appear not good either.
- If the eggs are not active during each of the intracellular fertilization steps, they would not fertilize. Consequently, ICSI would appear as unsuccessful.
- In case the sperm DNA stays in the sperm head, they cannot de-condense and the fertilization would fail. Or, fertilization would occur but not normally.
However, all this is in concern with the fertilization rate, and not the pregnancy rate. The outcome of that depends on factors like the quantity of the sperm, egg quality, and even the age of the woman. As for the pregnancy rates, some studies show favorable success rates over ICSI-less IVF treatments too. These occur if the egg quality and quantity are good in the female. If they are younger, that is more likely.
In cases of male infertility, the woman partner must have higher-quality eggs. However, if the egg quality and quantity (or either of the two) lessens, success is difficult to achieve.
Overall, you can go forward with an ICSI treatment plan and to increase your chances of getting a fertilized egg. However, pregnancy is a different circumstance, and ICSI does not lessen nor heighten its chances compared to conventional IVF.
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Dr. Jay Mehta
Fertility and IVF Specialist
Dr. Jay Mehta is the Scientific Director of Shree IVF Clinic. He is a well-known Fertility and IVF Specialist and also among few doctors in the country who specializes in Embryology and Andrology.