Intracytoplasmic Sperm Injection (ICSI) is performed as an additional part of an IVF treatment cycle where a single sperm is injected into each egg to assist fertilisation using very fine micro-manipulation equipment. In most cases, ICSI can be used to overcome severe male infertility.
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This involves the use of a hormonal drug treatment that stimulates maturation of multiple eggs in the ovaries, in order to create several viable embryos (the following fertilization), also to significantly increase the probability of maintaining the potential for pregnancy and preventing the need for repeated treatments.
Hormone preparation for ICSI involves drugs that prevent rupture of mature follicle (ovulation), which allows doctors to perform a minimally invasive oocyte aspiration procedure.
Depending on the sperm count, if the number of sperm in an ejaculation sample is insufficient, the specialist may have to perform an aspiration (fine needle technique) to extract sperm. If this too, is insufficient, then a testicular sperm extraction (TESE) or biopsy is undertaken.
Intracytoplasmic sperm injection is performed under microscopic control. A single sperm is injected into the cytoplasm of the retrieved egg. Experts at HMC carefully control the process of fertilization and the embryos are moved to a special incubator.
Within the 48 hours that follow ICSI fertilization, there is much cell division of the embryo. Specialists then select the healthiest embryos and transfer them to the uterus. Patients have the option to cryopreserve the viable embryos that were not transferred to the uterus. Implantation of the embryo, a few weeks later if the treatment is successful and there is a positive pregnancy result (after 14 days), specialists continue to perform a routine ultrasound to monitor pregnancy.
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Needle aspiration is a simple procedure performed under sedation with minimal discomfort; however, there is the potential for pain and swelling afterward. The sperm obtained from the testis is only appropriate for ICSI procedures when testicular sperm is not able to penetrate an egg by itself.
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Intracytoplasmic sperm injection is recommended for couple’s who have been diagnosed with male fertility issues such as low sperm count, low sperm morphology or motility, anti-sperm antibodies or have previously had a vasectomy or unsuccessful vasectomy reversal.
We can also use this technique for couples who have experienced poor or no fertilisation rates using standard IVF. Patients are electing to undergo ICSI for reasons other than male factor infertility, including:
Many patients choose to undergo the ICSI procedure in order to maximize their success even when the procedure is not clearly indicated.
If you have been told that there are abnormalities with any sperm test results, you should give serious consideration to ICSI. If the male partner has had a vasectomy reversal, we also recommend ICSI regardless of the sperm quality because of the presence of sperm antibodies that may affect fertilization.
The decision to proceed with ICSI is particularly difficult if there is no prior evidence of male factor infertility. Some couples choose ICSI because they want to do everything possible to maximize fertilization. However, it is important to understand that for many couples with normal sperm parameters, maximal fertilization can be achieved with standard insemination during IVF without the use of ICSI.
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ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won't seem much different than an IVF treatment without ICSI.
As with regular IVF, you'll take ovarian stimulating drugs, and your doctor will monitor your progress with blood tests and ultrasounds. Once you've grown enough good-sized follicles, you'll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle.
Your partner will provide his sperm sample that same day (unless you're using a sperm donor or previously frozen sperm.)
Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved.
If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval.
You can get more detailed information here in this IVF Treatment Step by Step.
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The most important indicator of ICSI success appears to be the fertilization rate achieved with the ICSI procedure. The fertilization rate in the UCSF IVF laboratory is exceptional currently 80 to 85 percent. That is to say, on average, eight out of every 10 eggs will fertilize normally.
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ICSI differs from IVF as each egg is individually injected with a single sperm, bypassing the stage where the sperm has to naturally penetrate the egg. ICSI is similar to IVF as eggs and sperm are collected from each partner or donor. On the day of egg collection, an embryologist inseminates the eggs and the following day selects out those that are fertilised. They are kept and monitored in an incubator for up to five days and the best embryos are transferred into your womb to implant.
ICSI can increase IVF success rates but the procedure is not perfect. Here are some more common risks associated with ICSI.
Damage to embryos. Fertilization rates with ICSI range from 50 to 80 percent. However, not all fertilized eggs develop into healthy embryos. Unfortunately, some eggs and embryos do become damaged during the ICSI process.
Becoming pregnant with multiples. Since ICSI takes place as part of the IVF process, there is an increased chance of becoming pregnant with multiples for couples that try ICSI. Couples that use ICSI with IVF have about a 30 to 35 percent chance for twins and a 5 to 10 percent chance for having triplets or more.
Carrying multiples increases your chances of developing the following complications during pregnancy and childbirth:
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If a woman gets pregnant naturally, there is a 1.5% to 3% chance that the baby will have a major birth defect. The chance of birth defects associated with ICSI is similar to IVF, but slightly higher than in natural conception.
The slightly higher risk of birth defects may actually be due to the infertility and not the treatments used to overcome the infertility.
Certain conditions have been associated with the use of ICSI, such as Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, or sex chromosome abnormalities. They are thought to occur in far less than 1% of children conceived using this technique.
Some of the problems that cause infertility may be genetic. For example, male children conceived with the use of ICSI may have the same infertility issues as their fathers.
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