Before a man’s sperm can fertilize a woman’s egg, the sperm head must attach to the outside of the egg.
This sperm then pushes the inside of the egg through the outer layer to conceive.
Sometimes the sperm is not able to penetrate the outer layer, due to various reasons, such as the inability of the sperm to float in the thick outer layer of the egg or may not be able to swim.
ICSI is a procedure that stands for intracytoplasmic sperm injection in which a single sperm is injected directly into the egg’s cytoplasm when done with in vitro fertilization (IVF), this can be helpful in fertilizing the egg.
ICSI is an assisted reproductive technology (ART) used to treat male infertility problems.
Overview of ICSI Treatment
ICSI or Intracytoplasmic sperm injection means the injection of a single live sperm into the center of a human egg or cytoplasm.
It is helpful for couples with severe male infertility or who have failed to fertilize in a previous in vitro fertilization (IVF) attempt. ICSI faces several barriers to fertilization that allow couples to successfully obtain a fertilized embryo.
Causes to consider ICSI
A serious male factor infertility with poor semen analysis where there is little or no sperm in the semen makes ICSI a necessity.
Causes of ICSI may include:
- The male partner produces very little sperm for artificial insemination (IUI or IVF)
- Unexplained infertility
- Sperms do not move naturally
- Previously poor fertilization with IVF
- Inconsistent sperm count
- An obstruction in the male reproductive tract
- Use of in vitro mature eggs or pre-frozen eggs
- It is difficult to attach the sperm to the egg
- Lack of fertilization of eggs by conventional IVF regardless of sperm status
The ICSI procedure is chosen by many patients to maximize their success rate even if the procedure is not explicitly suggested.
Patients with abnormalities in the results of any sperm test should seriously consider ICSI.
Dr. Shivani Bhutani, a best IVF Specialist in Ludhiana says that ICSI is also recommended if, regardless of the quality of the sperm of the male partner, sterilization is reversed because the presence of sperm antibodies can affect fertilization in these cases.
Couples wishing to test embryos for some genetic problems also sometimes choose ICSI because the procedure uses only one sperm for each egg and the genetic test is unlikely to be contaminated by the other sperm.
Collection, injection, and transfer of Sperm
Sperm are surgically removed from the testicles by a small incision if they cannot be collected by masturbation.
This technique is used for cases where there is a blockage preventing the ejaculation of the sperm or there is a problem in the growth of sperm.
Genetic problems that can affect offspring with few or no sperm in a man’s semen, a genetic test may be recommended before starting ICSI.
To initiate the development of many mature eggs, the female mate is given ovarian stimulation with fertility drugs, which are then aspirated through the vagina using vaginal ultrasound, and incubated under special conditions in the embryology laboratory.
A semen sample is prepared by rotating the sperm cells through a special medium to separate the living sperm from the dead sperm.
A single living sperm is carefully picked up by an embryologist in a glass needle and injected directly into the egg.
Eggs are then checked to see if they have been fertilized, after being modified overnight in a laboratory.
Eggs that are successfully fertilized after incubation or take 3 to 5 days to develop further are carefully selected and one or more of them are fitted with a catheter inserted through the cervix to place them in the uterus.
On the basis of the patient’s age and other criteria, the doctor suggests the number of embryos is transferred. Freezing other embryos for future use may be recommended.
During the procedure of ICSI, efforts are made to lay as many eggs as possible.
However, only mature eggs can be inoculated with sperm. For an immature egg fertilized with sperm, the chances of conception are very low.
On average, 75 percent to 80 percent of the eggs recovered can be injected.
What to expect after IVF treatment?
The entire process of In Vitro Fertilization (IVF) can be emotionally and physically demanding for the mother, as there is a need for regular blood tests, daily shots, and periodic monitoring by a doctor.
Although performed on an outpatient basis, these procedures require only a brief recovery time. Difficult activities may be avoided for the rest of the day.
ICSI success rate
Many couples with severe male-infertility problems have good success rates with ICSI.
During ICSI nearly 50% to 80% of the eggs are fertilized, which is equal to the fertilization with the normal sperm, and pregnancy rates have been seen with IVF in couples who have no male factor infertility. In layman’s terms, on average, eight out of 10 eggs are usually fertilized with ICSI
Risks associated with ICSI
Most of the risks associated with ICSI are similar to those of in vitro fertilization.
However, there are some problems that can occur during or after the ICSI procedure, such as a small number of eggs, usually less than 5% loss, or not growing even after injection into a fetus with sperm. Sometimes the fetus may even stop growing.
Superovulation with hormone therapy can sometimes lead to severe ovarian hyperstimulation syndrome (OHSS).
However, this risk is reduced by closely monitoring the patient’s ovaries and hormone levels by the doctor during treatment.
For a woman who becomes pregnant naturally, the chances of having a major birth defect are always 1.5% to 3%. The overall risk of having a child with chromosomal abnormalities related to ICSI is similar to that of IVF but slightly higher than that of natural conception.
The below problems can be attributed to sex chromosome abnormalities:
- Possibility of behavioral or learning disabilities
- Increased risk of infertility in children during adulthood
- Heart problems for affected babies requiring surgery
- The chances of miscarriage are high
One thing to note here is that the increased risk of birth defects may actually be due to infertility and not to infertility treatments.
However, the likelihood of a chromosomal abnormality such as Down syndrome does not increase with ICSI but actually increases with maternal age.
Once conceived, the chances of having more than one pregnancy are equal to IVF with or without ICSI.
There is also no difference in overall fetal quality or pregnancy rates with ICSI embryos compared with non-ICSI embryos.
A Very effective treatment for sperm-related infertility, ICSI can carry genetic risks that are more likely because of infertility than by the procedure itself.
Couples who are afraid of chromosomal problems may seek genetic counseling before treatment to know about the possibility of having a baby with a birth defect.
Talk to your doctor about examining the embryo before transferring it to the mother.
With all the risks and success rates considered, ICSI is proving to be a boon for couples who want to have children, especially with male factor infertility.
You can consult Dr. Shivani Bhutani at Eva Hospital to know more about treatment plans on the basis of your age, problem, and other factors. Remember that consulting a doctor is the first step towards making your child’s dream come true.