Intracytoplasmic Sperm Injection (ICSI)

What is ICSI?

Intracytoplasmic Sperm Injection, which is also commonly known as ICSI is one of the common and most successful treatments for male fertility. This process is also performed by couples who were unsuccessful to fertilize during IVF. Sometimes some men need their sperm to be surgically extracted first.

The process asks for the female partner to go through ovarian stimulation with the help of fertility medications. ICSI treatment can help to have a baby even if with low male sperm count issues. This process includes injecting the live sperm directly into the human egg.

About 75% of all the in vitro fertilization cases are now ICSI. In the case of male factor infertility followed by abnormal semen analysis, doctors recommend going for ICSI. Your doctor may also recommend you for ICSI treatment if you are having some issues like:

• Low sperm count.

• You’ve had IVF earlier but very few or none of the eggs fertilized.

• Your sperm don’t move normally or they are abnormally shaped.

• You are using frozen sperm for your treatment and the quality is low because of its storage and was under threat.

• You had a vasectomy or a blockage that prevents the sperm from reaching discharge.

ICSI is performed in a laboratory and is a part of IVF. ICSI – IVF is one of the specialized forms of In vitro fertilization (IVF) that is performed in the case of repeated failed fertilization attempts with the help of conventional IVF. It is also performed after the freezing of egg or male infertility.

In the case of IVF, doctors place more sperm together into the egg expecting that any one of the sperms will enter the egg and begin the process of fertilization. But in the case of ICSI-IVF doctors take a single sperm and puts it directly into the embryo.

ICSI-IVF is recommended by many doctors to infertile couples. It has enabled couples to get pregnant when without this process it was impossible to conceive with their egg and sperm.

ICSI-IVF is not only performed for the above-mentioned issues. In the case of Preimplantation Genetic Diagnosis  commonly known as PGD doctors suggest going for ICSI – IVF. In the case of a regular fertilization process, many sperm cells that have not fertilized the egg hang around the embryo. It causes interference with the exact PGD result. Hence doctors suggest ICSI – IVF.

ICSI is normally a part of the IVF process. The process includes a single sperm being injected at the center of the egg by a doctor. After the sperm has been injected into the egg, doctors wait for a few days to see the result. If the egg starts to fertilize and the embryo matures the doctor transfers it into your uterine cavity.

Steps involved in ICSI-IVF procedure:-

• Ovarian Simulation
  

A scan is performed to confirm that the ovaries are quiet and there is a thin lining of the womb. Women with the down-regulation regime will tend to have nasal sniff or down-regulation injections along with injections of stimulations until further instructed.

There are self-administered injections that come with an adjustable pen, vials, or ampoules that are mixed with water. Doctors will show you the technique and they will also provide a DVD or handwritten instructions for you to follow at home.

You will also be provided with a detailed timetable which consists of the days of injections and scans. The duration of this treatment is 10-12 days. There is also a need for regular interval blood tests and scans. Scans will help to monitor the response of the ovaries. On a scan, follicles can also be seen which may contain eggs. Therefore, doctors advise taking injections at the same time of the day.

• Egg Collection

The next step of the treatment is egg collection. It is always performed under strong painkillers or sedation or sometimes general anesthesia is also performed.

When a scan confirms the right stage of maturity of the follicles an injection is administered. Just before 35 to 36 hours of egg collection, the injection is administered. The timing is very important in this phase. The injection is administered in the evening because after that day there will be no medication for you. You will be advised to fast that night.

You are advised to refrain from sex for 3-5 days. It helps to know that the quality of sperm on that day is optimal. Your partner will be asked to provide a semen sample when it is time for egg collection. The process is always recommended to happen at the medical center and not at home.

Once you are under anesthesia or sedation doctors will need 20-30 minutes to retrieve the eggs from the ovaries. Doctors locate each follicle in the ovaries. Each follicle is punctured using an ultrasound scan by using a fine needle. This needle helps to draw fluid from each sac into a warm sterile tube.

The tube is further examined under a microscope. Every follicle does not produce mature eggs. There are also some empathy follicles containing eggs that even stopped growing and further disappeared. Other follicles too contain eggs but sometimes they are too young for fertilization.

• Medication

You will be under medication, especially progesterone support. It is a kind of hormone that helps in the good development of the womb. The medication is continued till the day of the pregnancy test and also beyond if the result of the test is positive. Sometimes doctors also add blood thinning injections, estrogen tablets, and even steroids if needed for your benefit.

• Laboratory

In the process of IVF, a large number of good-quality sperm are added to each egg in a small dish. Furthermore, they are placed in incubators which helps the sperms and eggs to be in body temperature. However, in the case of ICSI, only a single sperm is selected and placed into each egg. And then these eggs and sperm are placed in the incubator.

The morning after the egg is being collected, doctors examine the dish in which the sperm are placed under a microscope. Fertilization is studied later on. It is seen that on an average basis, 60% of the eggs injected by the process of IVF start fertilizing and 70% of the eggs injected via ICSI fertilize normally.

For the next 1 – 4 days, the embryos that split are replaced in the incubator. The embryos are checked daily to confirm the quality, and quantity of the embryo. It also indicates the perfect time to transfer.

• Embryo Transfer

After the eggs are collected, from day 2 to day 5 the embryos can be transferred. Sometimes in rare instances, the embryos can also be transferred on day 6. If in any case, the embryo reaches the blastocyst stage, which is the 5th day after the egg collection the chances of pregnancy increase.

The embryos can also be transferred on day 3 if they become 6 to 8 cells or if the quality matches with what is needed and can be also cultured to embryos that reached the blastocysts stage.

Two of the strongest embryos must be chosen for replacement but doctors find it more appropriate to transfer one or three embryos.

A tiny needle is used to place a single sperm into the center of the egg. After the sperm is injected embryologists wait for the result. The process is carried under a powerful microscope. Once fertilization begins, the egg continues to divide forming an embryo. Once the embryo is 3 days old and consists of 8 cells, it is ready to be transferred into the woman’s womb. Sometimes the transfer is also done on day 5 which is known as Blastocyst transfer.

People from all over the world come to India for ICSI – IVF treatment. In India, people find the treatment is half of the cost as compared to other countries. The treatment in India is also performed by a skilled medical team.

The cost of ICSI is not always included in the price of IVF. In India, you will find the cost of ICSI ranging from Rs.2,40,000 to Rs.2,50,000 per cycle. This includes only traditional techniques. Depending upon the case the amount also differs. The advanced treatments can also go up to Rs. 4,50,000 for one sitting.

You will find data suggesting IVF or ICSI-IVF is safe. But the risk is both for the mother and the newborn. Some of the risks are:-

• Multiple Gestation
• Hormone abnormalities in the offspring
• Preterm delivery
• Delayed development in children
• Heart defects in babies
• Hypospadias

Pros:

Doctors’ advice for ICSI or couples who opt for ICSI has fertility issues or ejaculation issues or issues related to male infertility. Any of the partners experiencing these issues can be benefited from ICSI treatment. It enables the male partner to get an opportunity to become the father of a child using his own sperm.

Even if the male partner undergoes vasectomy, ICSI is a good option for them. In the process of ICSI couples can also opt for donor sperms.

Cons:

There lie some risks with ICSI also. Once the sperm is obtained from a male partner, he is not subjected to any risk. The risks lie with the techniques being used for sperm recovery. Not all eggs fertilize into healthy embryos.

It is possible sometimes for them to get destroyed. During this process, mothers have a chance of carrying twins or triplets which can lead to certain complications. The risk of birth defects is also seen in the process of ICSI.

The process of ICSI fertilizes 50% to 80% of eggs. ICSI is an option added with IVF for severe male infertility or for couples who faced multiple pregnancy issues.

Fertilization is never guaranteed even after the sperm is injected into the egg. But ICSI can give you some hope.  ICSI is the most used method of fertilization accounting for 70% to 80% of the success rate. Reports favor the use of ICSI as it increases the rate of childbirth.