ICSI in Iran

What Is ICSI?

Intracytoplasmic sperm injection (ICSI) is an infertility treatment. It involves injecting live sperm into a person’s eggs in a lab. This method can create an embryo (fertilized egg). ICSI is a type of IVF. Doctors usually use ICSI when male infertility affects a man’s ability to have children.

How Does ICSI Work?

Your treatment will be the same as IVF. The only difference is that a skilled embryologist injects a single sperm into the egg instead of mixing the sperm with the eggs and leaving them for fertilization. This maximizes the chances of conception because it bypasses any potential problems the sperm will have in getting into the egg.

How Is ICSI Different from IVF?

ICSI is a type of IVF. With traditional IVF, the doctor places thousands of sperm next to an egg in a laboratory dish. Whether or not one of the sperm penetrates the egg to fertilize it is left to chance. If none of the sperm fertilizes the egg, conception (fertilization) does not occur.

ICSI enhances fertilization through the direct injection of a single sperm into an egg. However, ICSI does not guarantee conception.

In both traditional IVF and ICSI, the doctor implants a fertilized egg (embryo) into your uterus. If the embryo attaches to the lining of your uterus, pregnancy occurs.

Who Needs ICSI?

ICSI is very useful for people experiencing male infertility. Your doctor may recommend ICSI if a person has:

. Low sperm count.

. Blockage in their male reproductive system.

. Inability to ejaculate.

. Poor sperm quality.

. Retrograde ejaculation (semen flows backward into the bladder).

You may also need ICSI if:

. Traditional IVF has not resulted in the creation of an embryo.

. The person providing the eggs is over 35 years old.

. You use previously frozen eggs or sperm to get pregnant.

When Is ICSI Needed?

ICSI is usually used when couples have severe infertility problems and other fertility treatments have failed. This method is usually used when the male partner does not have enough sperm or cannot produce sperm.

In general, the conditions that lead to the use of ICSI treatment are:

. Absence of sperm in semen sample

. Low sperm count or oligozoospermia

. Low sperm motility

. Improper and abnormal shape of the sperm

. Damage or absence of the vas deferens in the male partner

. When there is an urgent need to remove the epididymis or testicles

. Having a vasectomy in the past

. Failure of previous IVF treatment

. Ejaculation disorders in men with spinal cord injury, diabetes, etc.

. The necessity of using frozen sperm

. Having non-obstructive azoospermia or NOA

. Low ovarian reserve

. Poor quality of eggs due to the old age of the mother

. The presence of some genetic disorders.

. A small number of eggs in the female partner

. Retrograde ejaculation

What Are the Success Rates of ICSI?

IVF with ICSI has a much higher success rate than conventional IVF. ICSI usually fertilizes 50-80% of the eggs on which it is performed. However, it is important to remember that no method can guarantee a 100% success rate. Even when sperm is injected directly into the egg, it may not fertilize the egg.

When the egg is fertilized, it must attach itself to the uterine lining and develop into a fetus. At this stage, the success rate of IVF with and without ICSI is the same. Therefore, the success rate of ICSI is not the same as the number of live births after an IVF cycle.

What Are the Risks and Benefits of ICSI?

What Are the Advantages of ICSI?

The benefits of ICSI are widely recognized. This method provides a satisfactory fertilization result to help people with infertility, reproductive system diseases, genetic disorders, or those who have failed other methods. ICSI advantages are as follows:

. ICSI reduces the risk of passing an inherited disorder to the fetus, such as thalassemia or Down syndrome.

. ICSI enhances the chances of conception compared to other methods by allowing sperm to freely fertilize eggs without having to penetrate the egg itself.

. ICSI enhances the chances of pregnancy for women over 35 who are infertile.

. ICSI allows men with low sperm count, poor sperm quality, poor morphology, or infertility to have children.

. ICSI allows couples to have children later in life when they are ready.

. ICSI enables couples who have undergone sterilization procedures, such as spermatic duct ligation or fallopian tubes, to have a successful pregnancy without undergoing sterilization reversal procedures.

What Are the Disadvantages of ICSI?

The Disadvantages of ICSI are as follows:

. ICSI is more expensive than IVF.

. ICSI carries the same risks associated with IVF, such as multiple pregnancies if more than one embryo is transferred, ovarian hyperstimulation syndrome (OHSS), and ectopic pregnancy.

. ICSI has been used for a shorter period of time than IVF. Therefore, experts are still learning about its possible side effects.

. The risk of neonatal abnormalities such as hypospadias may be higher in male infants.

. During natural fertilization, only the toughest sperm can travel long distances and cross the egg membrane to fertilize it. Weaker sperm do not make it. However, because ICSI bypasses this natural selection process, there is a slightly increased risk of developing rare genetic problems that the sperm will pass on to the baby. Some, but not all, genetic problems can be tested for before treatment begins.

What Are the Risks and Complications of ICSI?

These complications may occur with ICSI:

. After sperm injection, the egg is not fertilized.

. Damage to some or all eggs during needle penetration.

. Embryo growth stops in the laboratory or after embryo transfer.

What Are the Risks of ICSI to the Baby?

ICSI may increase a child’s risk of:

. Beckwith-Wiedemann syndrome (a growth disorder).

. Angelman syndrome.

. Sexual differentiation disorders.

. Autism.

. Hypospadias.

. Intellectual disabilities.

What Happens Before ICSI?

Before performing ICSI, your doctor must collect the eggs and sperm. These steps are done to retrieve the egg:

. Ovulation induction (also called ovarian stimulation): The person providing the eggs will receive medication injections for 8 to 14 days. This will stimulate your ovaries to produce multiple eggs at the same time to mature. And then, an injection of Lupron or human chorionic gonadotropin (hCG) helps the final maturation of the eggs.

. Egg retrieval: Your doctor uses transvaginal ultrasound technology to insert a thin needle through the vaginal wall into the ovaries. This step is done with a mild anesthetic, so there is no pain. A suction device attached to the needle draws out and collects the eggs.

Unless you are using frozen sperm, sperm collection is done on the same day as egg retrieval. The person who supplies the sperm:

. Refrains from sexual intercourse and masturbation (no ejaculation) for 2 to 3 days before the sperm collection.

. Masturbates at home or in a private room in a fertility clinic and collects the ejaculate in a container provided in the laboratory. The sample must be received by the laboratory within 60 minutes of ejaculation.

Semen analysis is performed immediately to check the volume, motility and quality of sperm. People who experience anejaculation, azoospermia, or retrograde ejaculation may need a sperm collection procedure. This is also true for people who undergo an unsuccessful vasectomy reversal. Procedures such as microscopic testicular sperm extraction and electroejaculation may be performed in a hospital instead of a fertility clinic. A laboratory may freeze and store the sperm (sperm banking) for later IVF use at the clinic.

How to Prepare for ICSI Treatment?

To increase your chances of getting pregnant through ICSI, you need to prepare your body and mind. Here are some valuable tips that will help you prepare for ICSI treatment:

. Maintain a healthy BMI: A balanced body mass index will help you conceive and carry a baby. By eating a healthy diet and exercising regularly, you won’t gain extra weight, so your chances of getting pregnant through ICSI will increase.

. Have a balanced and nutritious diet: From the first stages of the ICSI procedure until the day of delivery, you should have a proper diet rich in protein and vitamins. Eating more vegetables, nuts and seeds, fish, fruit, fresh and low-fat dairy products, whole grains, vitamins (natural or synthetic), and plenty of water before and after ICSI treatment is recommended. It is also useful if you avoid red meat, salt, and alcohol until after delivery.

. Relax and avoid stress and anxiety: Although anxiety is normal before an ICSI procedure, you need to manage your stress. Stress and anxiety directly affect your hormones and blood circulation and can cause ICSI to fail. Therefore, you can practice daily yoga, breathing techniques, and meditation to reduce stress before undergoing this treatment.

. Avoid unhealthy habits: From the moment you decide to get pregnant, you should avoid unhealthy habits like drinking alcohol, caffeinated drinks, eating junk food, smoking, etc.

What Should I Expect During the ICSI Procedure?

During ICSI, your doctor:

1. Will use a pipette (a small glass tube with a suction bubble) to hold the mature egg on a lab dish.
2. Will immobilize and collect the sperm using a thin needle.
3. Will insert the needle into the egg to reach the cytoplasm.
4. Will Inject the sperm into the cytoplasm.
5. Will remove the needle from the egg.

What Happens after ICSI?

After ICSI, the doctor monitors the fertilized egg in the lab for signs of successful fertilization.  Within five to six days, a healthy fertilized egg should divide into cells to form a blastocyst. Your doctor will evaluate the size of the blastocyst and its cell mass to determine when pregnancy is most likely.

Embryo transfer takes place on the fifth or sixth day after the egg retrieval procedure, or usually the transfer is delayed for a month or even years. The doctor will talk to you about the time of embryo transfer. Using ultrasound technology, the doctor inserts a catheter (a long, thin tube) into your vagina and injects the embryo into your uterus. For pregnancy to occur, the embryo must implant (attach) to your uterus. Your healthcare provider may recommend waiting at least two weeks before taking a pregnancy test.

Care After Embryo Transfer in ICSI Treatment

Some precautions after embryo transfer in ICSI treatment are:

1. Avoid stress

A small study in the UK found that patients with lower stress levels after embryo transfer were twice as likely to get pregnant.

2. Cut out your caffeine

If possible, one should try to stop consuming caffeine completely. Decaffeinated drinks should be chosen instead. If you can’t, reduce it to a maximum of 200 mg per day.

3. Avoid any heavy lifting

Try to avoid heavy lifting or heavy household chores. Get help from your spouse and family if needed.

4. Avoid vigorous Exercises

Moderate and light exercise and walking are good, but vigorous exercise should be avoided. Intense or aerobic exercise is prohibited after embryo transfer.

5. Avoid sexual intercourse

Sex after embryo transfer is not recommended at all because it may cause vaginal infection. You should even avoid masturbation. Give your body time to heal, adjust and relax.

6. Avoid douching and hot baths

Douching and hot baths and should be avoided because they may lead to infection. Infections are more likely to cause miscarriage. To prevent any foreign material from entering the vagina and causing infection, showering is a better option than taking a hot bath and swimming in a pool.

7. Medicines should be taken on time

From prenatal vitamins and folic acid to progesterone suppositories or injections, all should be taken on time as prescribed by your doctor. These medications help reduce birth defects and give the embryo strength and a favorable environment to grow.

8. Avoid smoking, alcohol, and drugs

Direct or secondhand smoking, alcohol, and drugs can all harm the fetus with their toxins. So, they should be avoided.

9. Healthy diet

Avoid eating unhealthy and junk food. Eat a healthy diet that should be a combination of fruits, vegetables, legumes, and foods rich in protein and carbohydrates.

10. Avoid prolonged bed rest

Lying in bed all the time will not improve your chances of getting pregnant. It might make it worse. People believe that complete bed rest helps implantation, but this is a myth.

These embryo transfer tips increase the chances of a successful pregnancy. Take the test when the time comes and don’t obsess about it. A little spotting and bleeding is also nothing to worry about but you should always consult your doctor for any doubts.