What is ICSI?
ICSI stands for Intracytoplasmic Sperm Injection and is aspecialization in In Vitro Fertilization. In couples where there is severe maleinfertility and is unable to conceive even after repeated fertilizationattempts by conventional IVF treatment or after egg freezing (oocytepreservation), ICSI is the next step in fertility treatment. If a man does nothave any sperm in his ejaculate, but he is producing spermin his testis, these produced sperms are retrieved through a surgical stepcalled as testicular sperm extraction (TESE). Sperm retrieved through TESE require the utilization ofICSI as they are not capable of fertilizing on their own. ICSI is also themethod of choice in cases of retrograde ejaculation, where the sperm retrievalis from the urine.
However, severe male infertility is notthe only cause, where ICSI-IVF has opted. Other reasons where ICSI is thechoice are:
• Previous IVF cycle had no or few fertilized eggs: In some cases, with agood number of eggs retrieval and healthy sperm count, but still, no eggs getfertilized. In such cases during the next IVF cycle, ICSI is tried.
• Frozen sperm is being used: If thethawed sperm appear to be inactive, ICSI-IVF is on a recommendation.
• Frozen oocytes are being used:Verification of eggs can cause hardening of eggshell, which causes complicationin fertilization. IVF with ICSI can help in overcoming this hurdle.
• PGD is being done: PGD(Preimplantation Genetic Diagnosis) is an IVF technique which allows geneticscreening of embryos. Here ICSI is essential for the embryo biopsy
• IVM (In Vitro Maturation) has opted:IVM is an IVF technology where eggs are retrieved from the ovaries before theyare completely mature. They go through the ultimate stages of maturation withinthe lab. Some research has found that the rate of fertilization of IVM eggs bysperm cells is lower when compared to fertilization through traditional IVF.But IVF with ICSI can be the only option in some select cases.
Who can opt for ICSI?
• Couples who want to include PGT intheir cycles to ensure fertilization is better.
• Couples who are facing severe maleinfertility
• When the only course of action is bysperm retrieval through TESE/MESA
• Poor oocyte quality/ low oocyte yield
• Suitable for women aged over 40 yearsof age ( to overcome sperm-Oocyte Penetration Issues)
• Couples who are facing repeatedfertilization failure
• Ejaculatory Dysfunction
The procedure involved in IVF-ICSI:
As with regular IVFprocedure, ovarian stimulation drugs are given.
Fertility Doctor monitorsthe progress with blood tests and ultrasounds.
Once enough good-sizedfollicles are produced, egg retrieval will be done, from the ovaries with aspecialized ultrasound-guided needle.
The partner provides spermsamples the same day(unless you are using a sperm donor or previously frozensperm)
Once the eggs areretrieved, an embryologist places the eggs in a specific culture medium.
Using a microscope and tinyneedle, the embryologist injects a single sperm into the egg cytoplasm. Theprocess will be for each egg retrieved.
These injected eggs arethen cultured in the lab, under ideal conditions, to allow the fertilized eggsto grow and divide.
If fertilization takesplace and if the embryos are healthy, they will be transferred into the femaleuterus via a catheter placed through the cervix, two to five days after theretrieval.
Risks involved with ICSI:
Even though thefertilization rates of IVF with ICSI can be as high as 50 to 80 per cent, not allfertilized eggs will develop into healthy embryos. A few or many of the eggsmay be abnormal, depending on the age of the women. Fertilization may result inabnormal embryos in some cases. Occasionally, eggs may get damaged in theprocedure. There is also a theoretical study that says ICSI allows lesshealthy sperm to fertilize an egg, which may result in defective embryos whichmay not develop and grow. These sperm would never have been able to fertilizean egg naturally.
The risk of defective birthin children conceived naturally is same as of with children conceived with IVFand ICSI. The risk of an ICSI-conceived child having defects is low, less thanone per cent. While, earlier studies found some specific risks ofdefective birth, which may be due to lower quality sperm (sex chromosomeabnormalities, defects in the urinary system or genitals, and other rare syndromes),more recent studies have found that the chance of this happening appears tobe almost non-existent.
Another risk of ICSI is arisk of the greater chance of multiple births than through natural conception.By carefully controlling the number of embryos transferred to the femalepartner’s uterus, this risk can be minimized. Multiple births as twins or more,may carry a higher risk of complications to both the mother and thebabies. However, cases of triplets or more are extremely rare.
If your fertility specialist doctorrecommends ICSI, find out the reason for the same and evaluate the risks andbenefits. IVF with ICSI makes it possible for thousands of couples around theworld to have a baby when the conditions are not conducive for natural conception.Consult a good fertility doctor and find out whether it’s the right treatmentfor you and your partner.
