Intracytoplasmic sperm injection (ICSI)

ICSI involves the injection of a single sperm into each oocyte using glass pipettes that are 20 to 60 times thinner than human hair. For this procedure, the oocyte is prepared by removing its outer coat of cells called the cumulus complex. A suitable sperm is selected using a microscope, and then sucked into an extremely fine glass pipette. This single sperm is injected directly into the cytoplasm of the oocyte in the lab. ICSI is a delicate but an effective technique. This improves the fertilization rate and offers hope to patients with severe male factor infertility.

How is ICSI performed?

There are basically five simple steps to ICSI which include the following:

» The mature egg is held with a specialized pipette.
» A very delicate, sharp, and hollow needle is used to immobilize and pick up a single sperm.
» The needle is then carefully inserted through the shell of the egg and into the cytoplasm of the egg.
» The sperm is injected into the cytoplasm, and the needle is carefully removed.
» The eggs are checked the following day for evidence of normal fertilization.
Once the steps of ICSI are complete and fertilization is successful, the embryo transfer procedure is used to physically place the embryo in the woman’s uterus. Then it is a matter of watching for early pregnancy symptoms. The fertility specialist may use a blood test or ultrasound to determine if implantation and pregnancy has occurred.

Are there specific situations where ICSI might be recommended?

ICSI may be recommended when there is a reason to suspect that achieving fertilization may be difficult. ICSI is most often used with couples who are dealing with male infertility factors. Male infertility factors can include any of the following: low sperm counts, poor motility or movement of the sperm, poor sperm quality, sperm that lack the ability to penetrate an egg, or azoospermia.

Azoospermia is a condition where there is no sperm in the male’s ejaculation. There are two types of » Azoospermia: obstructive and non-obstructive.

» Obstructive azoospermia may be caused by any of the following:

» Previous vasectomy
» Congenital absence of vas
» Scarring from prior infections
» Non-obstructive azoospermia occurs when a defective testicle is not producing sperm. In the case of azoospermia, the probability of obtaining usable sperm is low, and the possibility of using donor sperm may be considered.

How is Sperm retrieved for use in ICSI?

» For men who have low sperm count or sperm with low mobility, the sperm may be collected through normal ejaculation. If the man has had a vasectomy, the microsurgical vasectomy reversal is the most cost-effective option for restoring fertility.

» Needle aspiration or microsurgical sperm retrieval are good alternatives when a competent microsurgical vasectomy reversal has failed, or when the man refuses surgery. Needle aspiration allows physicians to easily and quickly obtain adequate numbers of sperm for the ICSI procedure. A tiny needle is used to extract sperm directly from the testis.

» Needle aspiration is a simple procedure performed under sedation with minimal discomfort; however, there is the potential for pain and swelling afterwards. The sperm obtained from testis is only appropriate for ICSI procedures when testicular sperm is not able to penetrate an egg by itself.