Intracytoplasmic sperm injection (ICSI)

Overview

Intracytoplasmic sperm injection (ICSI) stands out as a targeted approach within the realm of in vitro fertilization (IVF) for addressing infertility issues. This advanced technique involves the precise injection of a single live sperm directly into the cytoplasm of an egg, which is the central gel-like substance made up of water, salts, and various molecules. The aim of ICSI is to enhance the likelihood of sperm entry into the egg, thereby increasing the chances of creating a fertilized egg or embryo.

Diverging from the conventional IVF method, which relies on placing numerous sperm close to an egg and leaving fertilization to occur naturally, ICSI adopts a more proactive strategy. By selecting and injecting a single sperm into an egg, ICSI significantly boosts the potential for fertilization, although it doesn’t ensure it.

After the fertilization phase, achieved via either ICSI or traditional IVF, the next critical step is the transplantation of the fertilized egg (embryo) into the uterus. The successful implantation of the embryo into the uterine lining is what leads to pregnancy. Utilized in roughly 60% of IVF treatments, ICSI is a form of assisted reproductive technology (ART) that aids in overcoming infertility by enabling conception outside the body. The success rate of fertilization through ICSI varies between 50% and 80%, making it on par with the success rates of conventional IVF techniques.

Reasons for undergoing the procedure

ICSI proves most beneficial for individuals dealing with male infertility. Your healthcare provider might suggest ICSI if a person:

• Low number of sperm.
• Poor quality of sperm.
• The inability to ejaculate, or anejaculation.
• An obstruction in the reproductive system of men.
• Retrograde ejaculation, in which the bladder receives semen backward.

ICSI might also be required if:

• The egg supplier is over 35 years old.
• You are attempting to conceive using previously frozen eggs or sperm (cryopreservation).
• Developing embryos has not resulted from traditional IVF.

Risks

Potential complications associated with ICSI include:

• Failure of fertilization after the sperm injection.
• Injury to some or all of the eggs during needle penetration.
• Halt in the development of an embryo either in the laboratory or after the embryo transfer.

The following conditions may somewhat raise a child’s risk:

• The growth abnormality known as Beckwith-Wiedemann syndrome.
• Sex differentiation disorders.
• Cognitive impairments.
• Angelman syndrome.
• Autism.
• Hypospadias

Before the procedure

Before ICSI can proceed, your doctor must retrieve the eggs and sperm.

The following steps are involved in egg retrieval:

• Ovulation induction (also known as ovarian stimulation): The individual providing the eggs undergoes medication injections for a period of eight to 14 days. These injections stimulate the ovaries to produce multiple eggs simultaneously, allowing them to mature. Following this, a Lupron or Human Chorionic Gonadotropin (hCG) injection is administered to aid in the final maturation of the eggs.
• Egg retrieval: Your doctor utilizes transvaginal ultrasound technology to guide the insertion of a thin needle through the vaginal wall into the ovaries. This procedure is carried out with a mild anesthetic, ensuring a pain-free experience. A suction device attached to the needle extracts and collects the eggs.

Unless frozen sperm is being used, sperm collection occurs on the same day as egg retrieval. The individual providing the sperm:

• Abstaining from sex and masturbation (no ejaculation) for two to three days prior to sperm collection is necessary. The individual providing the sperm.
• Masturbates at home or in a private room at a fertility clinic, collecting the ejaculate into a lab-provided container. The specimen must be delivered to the laboratory within 60 minutes from ejaculation.
• A semen analysis is conducted promptly to assess sperm volume, mobility, and quality. Individuals with conditions like azoospermia, anejaculation, or retrograde ejaculation may require a procedure to collect sperm. This is also applicable for those who undergo an unsuccessful vasectomy reversal. Procedures like electroejaculation and microscopic testicular sperm extraction may be performed in a hospital rather than a fertility clinic. The sperm can be frozen and stored (sperm banking) for future use in IVF at the clinic.

During the procedure

Your doctor will:

• Hold the mature egg in place on a lab plate using a pipette, a small glass tube with a suction bulb, during ICSI.
• Employing a tiny needle to immobilize and remove a single sperm.
• To access the cytoplasm, insert the needle into the egg.
• The sperm is injected into the cytoplasm.
• Removes the needle from inside the egg.

After the procedure

Following ICSI, your doctor monitors the fertilized egg in the laboratory to observe signs of successful fertilization. Within five to six days, a healthy fertilized egg should undergo cell division, forming a blastocyst. The doctor evaluates the blastocyst’s size and cell mass to determine the optimal time for potential pregnancy.

Embryo transfer typically occurs on the fifth or sixth day after the egg retrieval procedure, although it may be delayed for a month or even years. Your doctor will discuss the timing of the embryo transfer with you. Utilizing ultrasound technology, a catheter (long, thin tube) is inserted into your vagina by your doctor to inject the embryo into your uterus. For a successful pregnancy, the embryo needs to implant (attach) to your uterus. Your doctor may recommend waiting at least two weeks before taking a pregnancy test.

Outcome

Recovery and prognosis differ based on the particulars of the IVF procedure.