ICSI Fertility Treatment

Overview

Intracytoplasmic sperm injection (ICSI) fertility treatment is a technical form of In Vitro fertilization (IVF) used for treating severe cases of male-related infertility. It involves the injection of live sperm directly into a mature egg. It is the most common and successful treatment for male infertility; it is performed as part of the IVF process.

Who might need the ICSI procedure?

ICSI may be recommended to a patient if:

• The patient has a low sperm count.
• The patient has experienced a futile IVF procedure or had very few eggs fertilized.
• The patient has poor sperm morphology and motility.
• The patient cannot ejaculate sperm and needs it to be collected directly from his testicles or epididymis.
• The patient wants to use frozen sperm for an IVF cycle.
• The patient has retrograde ejaculation.
• The egg donor for the IVF cycle is older than 35.

What is the difference between ICSI and IVF?

ICSI is a procedure that falls under IVF. In the traditional form of IVF, the egg is placed on a petri dish, and the sperm sample is placed on that dish, leaving the fertilization up to chance. In this scenario, it is also possible that the egg does not get fertilized by a sperm cell, and conception doesn’t occur. ICSI causes fertilization by the direct injection of a single sperm cell into a mature egg. But even with this, ICSI does not fully guarantee fertilization though it gives the best chance for it to occur. The common denominator in both IVF and ICSI is that in the instance of fertilization, the egg is then implanted in the uterus. Pregnancy then occurs if the implanted embryo attaches itself to the lining of the uterus.

What is the success rate of ICSI fertility treatment?

It is estimated that approximately 6 out of 10 IVF procedures take place using ICSI. The chances of having a successful pregnancy are just about the same with traditional IVF. Around 50-80% of ICSI attempts result in fertilization.

What happens before ICSI?

Before ICSI can take place, other processes precede it in the IVF cycle, they include:

• Administration of fertility medication – The egg donor is placed under fertility medication which stimulates the ovarian follicles. The medication is given for about 8-14 days; they stimulate the ovaries to mature multiple follicles at once. Then a trigger hCG shot is administered which helps in the final maturation of the egg before they are retrieved.
• Retrieval of the egg – This is done by a trained surgeon, who uses a thin hollow needle connected to a catheter with a small suction to aspirate the follicular fluid containing the mature egg. This procedure is guided by transvaginal ultrasound. The procedure is done with the patient under sedation so there is minimal pain and discomfort.

Sperm collection will also be done on the same day as the egg is retrieved unless the sperm has already been collected previously and frozen. If the sperm is collected on the day, a semen analysis is carried out to check the qualities like volume, mobility, and morphology. 

The normal procedure for the collection of sperm is for the donor to ejaculate into a lab-provided container. However, in cases where the donor is unable to ejaculate, has retrograde ejaculation, or has azoospermia, a procedure would have to be done to extract the sperm cells. This procedure may also be done on patients that have had a vasectomy and had an unsuccessful reversal. Microscopic testicular sperm extraction may take place in a hospital rather than in a fertility clinic, after which the collected sperm is frozen and stored, awaiting use in IVF at the fertility clinic.

What is the process of ICSI fertility treatment?

The doctor in charge of the IVF process uses a pipette to hold the mature egg inside a petri dish in place. They use a thin needle to pick up one sperm cell. They then insert the needle into the egg to access its cytoplasm, inject the sperm directly into the cytoplasm and finally withdraw the needle from the egg.

What happens after ICSI?

The doctor monitors the fertilized egg in the lab for any sign of successful fertilization. There should be division in a healthy fertilized egg within 5-6 days post fertilization, forming a blastocyst. The blastocyst is screened to determine if it will lead to successful implantation and subsequent pregnancy. After which an embryo transfer into the uterus of the woman occurs. The transfer is usually done about six days following egg retrieval. The exact timing is stated by the doctor in charge of the IVF process.

The process of injection of the embryo is similar to the egg retrieval process in that an ultrasound is used to guide a needle that injects the blastocyst into the uterus. The injection is done in a region that will give the best chance of implantation of the embryo. The attachment of the embryo to the lining of the uterus (implantation) signals the success of the transfer. This is confirmed by pregnancy tests about two weeks following the transfer.

What are the complications and risks of ICSI?

Some of the complications that may arise following the ICSI procedure include:

• The egg is not fertilized even after the injection
• Damage to the egg by the needle during injection
• The embryo stops developing
• Ovarian hyperstimulation
• Miscarriage
• Ectopic pregnancy

Does ICSI pose any risk to the baby?

Medical experts believe that any congenital anomaly resulting from an ICSI fertilized embryo may be from the underlying cause of infertility instead of the actual procedure. Even then, the risk of congenital anomalies is still small since birth defects occur in about 2% of newborns annually. However, ICSI may slightly increase the risk of a child to the following conditions, they include:

• Angelman syndrome
• Intellectual disabilities
• Sex differentiation disorders
• Autism
• Hypospadias

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