Intracytoplasmic sperm injection, commonly known as ICSI, is a method that implements Assisted Reproductive Technology (ART), in order to help a couple conceive. ICSI has been developed to overcome male infertility that is due to impaired semen quality.In this technique a motile, normal shaped sperm is selected, immobilised and placed inside the egg using a fine needle. The sperm is directly injected into the egg using a micromanipulator. This is done using an inverted microscope under high magnification, in order to try to achieve fertilization and create embryos for transfer later.

When and why is ICSI needed?

Conception through ICSI is recommended in the following cases:

  • Ejaculatory problems
  • Problems in getting an erection
  • Extremely low or zero sperm count
  • Oddly shaped sperms
  • Reduced motility

How is ICSI carried out?

Like an IVF cycle, the ICSI procedure also begins with giving fertility drugs to the woman in order to reach superovulation. Once this stage is achieved, the eggs are extracted from the woman’s ovaries and are kept in a controlled setting in the embryology laboratory. Simultaneously, sperm are received from the man, by providing an ejaculated sample or using a surgically retrieved sample that is prepared to collect the fastest motile.

The main ICSI process starts with an injection of the healthiest sperm into the egg, using a glass needle. The next day all eggs are observed for normal fertilisation, All normally fertilized eggs will be monitored daily.The most developed embryo(s) will be selected and implanted into the woman’s uterus with the help of a catheter. If the embryo(s) implant into the wall of the uterus, pregnancy is achieved.

Ovarian Stimulation

One or two eggs are produced by the ovaries every month in the natural menstrual cycle. In an IVF cycle the aim is to obtain more eggs, and thus to be able to create more embryos, by the administering hormones to stimulate egg production by the ovaries.

Follicular Puncture (oocyte pickup or egg retrieval)

The development of follicles will regularly be monitored by ultrasound. This will allowfor the best time for the triggering of ovulation by the application of a hormonal injection called human Chorionic Gonadotrophin (hCG).The egg collection (Follicular Puncture) will be scheduled 34-36 hours after this injection. The egg collection procedure is performed using a fine ultrasound-guided needle, underlocal anesthesia or in some cases under general anesthesia.

Oocyte Fertilization and Embryo Culture

The same day of oocyte pick-up procedure, the husband has to provide a semen sample, which is prepared and used for fertilizing the oocyte by injecting each oocyte with a single sperm (ICSI). The oocytes will be cultured overnight in incubators with controlled parameters of temperature and gas concentration to  achieve hopefully good quality embryos.

To ensure that there is no mixing up of the sperm and eggs, our lab is working with “RI-Witness” system. Moreover, all the incubators in the lab are continuously monitored externally by the “Xiltrix system” to ensure a safe environment for the embryos.

Embryo Transfer

The embryos are evaluated daily to monitor their progress. To determine the best day for transfer, several factors have to be considered:

  • previous treatment history
  • the development of the embryos (cell number and quality)
  • and also whether any genetic testing will be done on the embryo

The physician and the embryologist will decide when to transfer the embryo(s) to ensure that the patient has the best chance of pregnancy.

The embryo(s) is/are transferred under ultrasound guidance into the uterus by using a thin catheter. It is a simple, and painless procedure, and sedation or anesthesia is not required. It is recommended to move immediately after the embryo transfer and not to remain in the bed.

How successful is an ICSI procedure?

The ICSI procedure isvital if the sperm is unable to reach the egg, and fertilize the egg. Since ICSI directly injects a sperm into the egg, chances of a successful pregnancy increase for couples where male factor or previous failure to fertilise with IVF is the cause of infertility.The rate of successful births although vary according to the woman’s age and the man’s infertility conditions.

What makes ICSI the best technique to conceive artificially?

Apart from the soaring success rate, ICSI also has certain advantages that make it superior.

  • Genetically modified zygotes: ICSI gives an opportunity for doctors to eliminate any undesirable genes that might lead infertility in any child, post puberty by combining the technique with pre-implantation genetic diagnosis (PGD).
  • Multiple births: The conception of twins, triplets etc, can be facilitated through ICSI, by injecting more than one embryos in the woman's womb.

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