Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat sperm-related infertility problems. ICSI is used to enhance the fertilization phase of in vitro fertilization (IVF) by injecting a single sperm into a mature egg. The fertilized egg is then placed in a woman’s uterus or fallopian tube.
Sperm collection.
If sperm cannot be collected by means of masturbation, they are surgically removed from a testicle through a small incision. This method of sperm retrieval is done when there is a blockage that prevents sperm from being ejaculated or when there is a problem with sperm development. The common sperm retrieval procedures are known as TESE or PESA
Ovulation and egg retrieval.
To prepare for an assisted reproductive procedure using your own eggs, you must get daily injections and be closely monitored for 2 weeks before egg retrieval. At home, you or your partner injects you with gonadotropin or follicle-stimulating hormone (FSH) to stimulate your ovaries to produce multiple eggs (superovulation). After the first week, your doctor checks your blood estrogen levels and uses ultrasound to see whether eggs are maturing in the follicles. During the second week, your dosage may change based on test results and ultrasound. If follicles fully develop, you are given a human chorionic gonadotropin (hCG) injection to stimulate the follicles to mature. The mature eggs are collected 34 to 36 hours later using Transvaginal ultrasound guided aspiration under short anesthesia.
Sperm injection and transfer:
Under high-power magnification, a glass tool (holding pipet) is used to hold an egg in place. A microscopic glass tube containing sperm (injection pipet) is used to penetrate and deposit one sperm into the egg. After culturing in the laboratory overnight, eggs are checked for evidence of fertilization. After incubation, the eggs that have been successfully fertilized (zygotes) or have had 3 to 5 days to further develop (zygotes or blastocysts) are selected. Two to four are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. The remaining embryos may be frozen (cryopreserved) for future attempts.
What To Expect After Treatment
Overall, in vitro fertilization (IVF)-related injections, monitoring, and procedures are emotionally and physically demanding of the woman. Superovulation with hormones requires regular blood tests, daily injections (some are quite painful), and frequent monitoring by your doctor.
These procedures are done on an outpatient basis and require only a short recovery time. Your doctor may advise you to avoid strenuous activities for the remainder of the day.
Why It Is Done
Intracytoplasmic sperm injection (ICSI) is used to treat severe male infertility, as when little or no sperm are ejaculated in the semen. Immature sperm collected from the testicles are usually unable to move about and are more likely to fertilize an egg through ICSI.
Some couples choose to try ICSI after repeat in vitro fertilization has been unsuccessful. In the United States, about half of IVF procedures are currently performed using ICSI technology.5
ICSI is also used for couples who are planning to have genetic testing of the embryo to check for certain genetic disorders. ICSI uses only one sperm for each egg. So there is no chance the genetic test can be contaminated by other sperm.
How Well It Works
Used with in vitro fertilization and eggs of good quality, ICSI often is a successful treatment for men with impaired or no sperm in the ejaculate. ICSI (using sperm collected from the testicles) produces an estimated 40-60% clinical pregnancy rate and 25% to 30% birth rate.
Treatment success versus the risk of multiple pregnancies
In order for a woman over age 35 to maximize her chances of conceiving with her own eggs and carrying a healthy pregnancy, she must have more embryos transferred than do younger women. This practice, though, increases her risk of conceiving multiple fetuses.
