ICSI

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What is IVF(In viro fertilisation)/ICSI? 

Intra Cytoplasmic Sperm Injection (ICSI) is an assisted reproductive technique where in a single sperm is injected into the cytoplasm of the oocyte (egg) with the help of special micromanipulators. This technique was initially used only for severe male factor infertility but is now being used to increase the chances of fertilization in other patients undergoing IVF cycles too.

Which patients should get IVF/ICSI done?

Patients with
  • Low sperm count
  • Unexplained failure or poor fertilization in previous IVF cycles.
  • Severe structural abnormalities of sperm.
  • Immotile sperm (Inherited disorders of the sperm tail like Kartagener's Syndrome).
  • Epididymal or testicular sperm obtained from Azoospermic patients (No sperm count in semen, but normal or low sperm production in the testis)
  • Sperm obtained by electro ejaculation or from urine in cases of retrograde ejaculation.
  • HIV / AIDS, Hepatitis A, B, C affected male partner.
  • Sperms retrieved from the testes of men who have in the past undergone a vasectomy that now cannot be reversed.
  • Couples who are planning to have genetic testing of the embryo during their invitro fertilisation cycles, to check for certain genetic disorders. ICSI uses only one sperm for each egg, so there is no chance the genetic test can be contaminated by other sperm.

How does ICSI help?

With ICSI, the sperm do not have to travel to the egg or penetrate the outer layers of the egg. Therefore it can help men whose sperm are too few, or cannot move properly, or where the sperm can get to the egg, but are unable to fertilize it for some reason. In conventional IVF, the eggs collected from the womens body were put in a petri dish with the partners sperm and the sperms themselves had to enter the egg and fertilize it. This led to a higher chance of fertilisation failure both in men with poor quality sperms and in slightly older women with harder egg shells. This drawback is overcome with the ICSI technique as here, using a very powerful microscope and very fine needle (micromanipulator), a sperm is injected into each egg thus facilitating fertilisation.

How is sperm retrieved for use in IVF/ICSI?

For men who have low sperm count and sperm with low mobility, the sperm may be collected through normal ejaculation. If the man has had a vasectomy, the microsurgical vasectomy reversal is the most cost-effective first choice option for fulfilling the desire to have children.

Needle aspiration or microsurgical sperm retrieval are good alternatives when a competent microsurgical vasectomy reversal has failed, or when the man is opposed to surgery. Needle aspiration allows physicians to easily and quickly obtain adequate numbers of sperm for the ICSI procedure. A tiny needle is used to extract sperm directly from the testis. Needle aspiration is a simple procedure performed under sedation with minimal discomfort; however there is potential pain and swelling afterwards. The sperm obtained from testis is only appropriate for ICSI procedures when testicular sperm is not able to penetrate an egg by itself.

How is IVF/ICSI done?

The initial steps until the oocyte pickup are similar to IVF(Invitro fertilisation). IVF differs from ICSI in the insemination methodology. In ICSI after the oocyte pickup, the cumulus cells around the egg are manually stripped. After stripping these eggs are placed in a tiny drop in a special dish. While viewing the egg and sperm through a microscope, a single sperm is captured in a fine glass needle and injected through the eggshell and into the center of the egg. Successful fertilization is evaluated the following day. Three to five days after ICSI embryos are transferred into woman's uterus.

What is the success rate for ICSI?

The success rate of ICSI is increasing as more and more clinics become experienced in this technique. The overall average success rate for women under 35 years is around 40 to 45%.

What are the advantages of ICSI?

ICSI opens doors to parenthood that were previously closed for couples with a male factor problem. It gives men with absent, few or immotile sperms the chance to have their own biological child, which might not have been possible without this technique. Sperms can also be retrieved from the testes of men who have in the past undergone a vasectomy that now cannot be reversed.

Are there any disadvantages of ICSI?

Nature follows the principle 'Survival of the fittest'. During normal conception, only the hardiest sperm manage to travel great distances and break through the membrane of an egg to fertilize it. Weaker sperm never make it. Because ICSI bypasses this process of natural selection, critics worry about higher rates of miscarriage, and long-term health & developmental problems for children conceived using whatever sperm are available. Research so far has been reassuring about most potential risks. No impact has been seen on the cognitive and motor skills of children conceived using IVF/ICSI.

Letters to Dr. Richa Katiyar regarding ICSI

Dear Dr.Richa,

Please let me know the success rate for ICSI treatment?

Could you please mail the clinic address, i am living in Noida, so if at all you do consultation in any of the hospitals in Noida also, then please let me know.

Regards,
Amna
Dear Amna,

Success depends on many parameters like your age, your AMH report, AFC, condition of the uterus, semen parameters etc. I will do your USG when you come to visit me and go through all your previous reports and will then be able to give you the success chances in your case.

Unfortunately I do not visit any Hospitals in Noida. My Clinics address is:

Dr. Richa Katiyar
Sector D, Pocket 2,
House No. 2482,
Vasant Kunj, New Delhi.

Regards,
Dr. Richa

I am Adil from Dacca.

Age 35+ and my wife age 33+. We have no baby after long time. we are trying in bangladesh in different doctors but we can't success. We want to go to your hospital recently. Can we any benefit from you. My sperms morphology is not good.

Thanks.
Hello Mr. Adil,

Even with average morphology, we can get good results in ICSI technique as the sperms are selected individually under high magnification.

Dr. Richa