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What is ICSI ?

Intra-Cytoplasmic Sperm Injection (ICSI) is a process where a single sperm is injected directly into the egg using a fine glass needle. The main objective of ICSI is to ensure that the spermatozoa fertilize the egg membrane…

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ICSI

The term ICSI refers to intracytoplasmic sperm injection. It basically involves retrieving the semen from the male, selecting the best sperm from it, and injecting it into the egg to fertilize it. This is one of the most successful methods of artificial treatment for infertility
ICSI is recommended in cases of severe male infertility, previous fertilization failures with IVF, or situations in which there are a limited number of oocytes available.
During the procedure, the female partner must undergo ovarian stimulation with fertility medications in order to produce several mature eggs. These eggs are then aspirated through the vagina using vaginal ultrasound, and incubated under precise conditions in the embryology laboratory. The sperm cells are centrifuged or spun through a special medium to prepare the semen sample. By doing this, live sperm is separated from debris and most dead sperm. The embryologist then picks up the single live sperm in a glass needle and injects it directly into the egg.
ICSI has a success rate of 80 to 85%. It is estimated that eight out of ten eggs will fertilize normally.

How is ICSI different from IVF?

The ICSI procedure is a form of in vitro fertilization. During traditional IVF, your healthcare provider places thousands of sperm next to an egg on a laboratory dish. There is no way to predict whether sperm will penetrate the egg and fertilize it. Conception (also called fertilization) does not occur if no sperm fertilize the egg.

In ICSI, a single sperm is directly injected into a single egg, resulting in fertilization. In spite of this, ICSI does not ensure fertilization.

Both ICSI and traditional IVF involve implanting the fertilized egg (embryo) into your uterus. When the embryo attaches to the uterine lining, pregnancy occurs.

Who needs ICSI?

Those with male infertility are most likely to benefit from ICSI. Among the conditions for which ICSI may be recommended by your healthcare provider are:
  • Inability to ejaculate (anejaculation).
  • Their male reproductive system is blocked.
  • The sperm count is low.
  • The sperm quality is poor.
  • Semen flows backward into the bladder during retrograde ejaculation.

 

ICSI may also be needed if:

  • Embryos have not been created through traditional IVF.
  • Women over 35 yrs of age due to low quality of eggs.
  • Using previously frozen eggs or sperm (cryopreservation) to conceive

What is the procedure for ICSI?

The ICSI procedure is part of IVF. As ICSI is done in the lab, you won't notice much difference between IVF with ICSI and IVF without ICSI. There might be a difference in how the sperm is extracted from the male partner, however.

For Women

Steps for a female partner are similar to those for IVF.

For Men

In the same manner, as regular IVF, the male partner will be asked to provide a sample of his semen on the same day as egg retrieval. Semen will be analyzed under a microscope and the best sperm will be extracted. The male partner may have to undergo some procedures for sperm extraction if the semen analysis shows hardly any viable sperm in the sample.

Depending on the cause of male infertility, sperm can be extracted from:

  • The epididymis (a narrow tube inside the scrotum, where sperm are stored and matured) is used using a type of fine syringe. It is also called PESA or percutaneous epididymal sperm aspiration.
  • Testicular sperm aspiration, or TESA, is another method of obtaining sperm from the testicles.
  • Alternatively, testicular tissues can be removed following a testicular biopsy. It is known as TESE, or 'testicular sperm extraction'.
    The embryologist will place the eggs in a special culture after retrieving sperm, and inject a single sperm into each egg using a microscope and a tiny needle. For each egg retrieved, this will be done. ICSI allows the complex process of fertilization to commence, even if the egg is not automatically fertilized.

    Just like a regular IVF cycle, one to three of the best-quality embryos are transferred to the womb.

    What happens before ICSI?

    The eggs and sperm must be collected before ICSI can take place.

    Retrieving eggs involves the following steps:

    • Ovulation induction (also called ovarian stimulation): Medication injections are given for 8-14 days to the person supplying the eggs. Your ovaries are stimulated to produce multiple eggs at once. An injection of Lupron or human chorionic gonadotropin (hCG) will assist in the final maturation of the eggs.
    • Egg retrieval: During egg retrieval, your healthcare provider inserts a thin needle through the wall of your vagina into your ovaries using transvaginal ultrasound technology. The procedure is done under mild anesthetic, so there is no pain involved. Using a suction device connected to the needle, the eggs are drawn out and collected.

      Sperm collection takes place on the same day as egg retrieval, unless frozen sperm is being used. The person whose sperm is to be taken:

      • For two to three days before the sperm collection, refrain from sexual activity and masturbation (do not ejaculate).
      • Masturbates at home or in a private room at a fertility clinic, collecting the ejaculate into a container provided by the lab. Within 30 minutes of ejaculation, the specimen must be received by the laboratory

        The semen is immediately analyzed to determine sperm volume, motility, and quality. Those who have azoospermia, anejaculation, or retrograde ejaculation may need to undergo sperm collection procedures. It is also true for those who have failed to reverse a vasectomy. Instead of a fertility clinic, electroejaculation and microscopic testicular sperm extraction may take place in a hospital. For later use in IVF, the sperm may be frozen and stored at a lab (sperm banking).

        What happens during an intracytoplasmic sperm injection?

        A healthcare provider will perform ICSI as follows:

        1. The mature egg is held in place on a lab dish using a pipette (small glass tube with a suction bulb).
        2. Using a thin needle immobilizes and picks up one sperm.
        3. The needle is inserted into the egg to reach the cytoplasm.
        4. The sperm is injected into the cytoplasm.
        5. Removes the needle from the egg

        What happens after ICSI?

        After ICSI, your healthcare provider monitors the fertilized eggs in the laboratory for signs of fertilization. A healthy fertilized egg should divide into cells within five to six days, forming a blastocyst. Depending on the blastocyst's size and cell mass, your healthcare provider will decide when it's most likely to result in a pregnancy.

        The embryo transfer usually takes place on the fifth or sixth day after egg retrieval, or it is delayed for a month or even years. The timing of your embryo transfer will be discussed with you by your doctor. Your healthcare provider will insert a catheter (a long, thin tube) into your vagina and inject the embryo into your uterus using ultrasound technology. To become pregnant, the embryo must implant (attach) to your uterus. You may be advised to wait at least two weeks before taking a pregnancy test by your healthcare provider.

        Benefits of ICSI

        ICSI can help couples struggling with infertility, especially when the issue is male-related. The main advantage of ICSI during IVF is an increased fertilization rate, which can increase the number of fertilized eggs that can be transferred or frozen. When couples struggle with male factor infertility, ICSI can also increase the chances of successful fertilization under normal insemination (such as IUI).

        What is the success rate of ICSI treatment?

        ICSI is used in approximately 60% of all IVF procedures, and it has been shown that the likelihood of a successful pregnancy is similar between ICSI and conventional IVF. ICSI can produce fertilization in up to 80% of cases when performed by top fertility doctors using cutting-edge equipment.

        The risks associated with ICSI

        If ICSI is done under proper supervision and at a reputable medical facility like Shukan IVF Center, there are not too many risks involved. In some rare cases, however, ICSI treatment may involve these risks.

        • In some cases, eggs might be damaged

        The risk of these complications is considerably lower if the ICSI treatment is performed in a high-quality facility like Shukan IVF Center.

        It's important to note that many couples undergo ICSI successfully without any complications. The ICSI procedure, however, can be a challenging and emotionally draining process for couples suffering from infertility. Working closely with a fertility specialist and following all recommended guidelines & precautions can reduce the risks associated with ICSI.

        Get in touch with Shukan IVF Center and speak to our fertility specialists to learn more about ICSI and explore your options.

        Cost of ICSI in India

        The cost of ICSI in India can vary depending on the clinic. At Shukan IVF, the base price for the treatment remains the same. However, a variable cost may be associated with the procedure due to the medication used. Any additional surgical procedures that may be required can also affect the total cost of IVF treatment.

        FAQs

        1. What is the difference between IVF and ICSI?

          There is a main difference between IVF and ICSI in the way the sperm fertilizes the egg. In IVF, the egg and sperm (of which there are many) are left in a petri dish to fertilize on their own. In ICSI, one sperm is directly injected into the egg.

        2. What causes ICSI failure?

          The inability of the sperm to activate the oocyte is the most common reason for unsuccessful fertilization following ICSI with round-head sperm. Some types of globozoospermia can also lead to fertilization failure due to nuclear decondensation arrest and/or premature chromosomal condensation.

        3. In order to perform ICSI, how many sperms are needed?

          By using ICSI, one sperm should be sufficient to fertilize an egg and produce a successful pregnancy.

        4. What factors affect ICSI?

          The success of ICSI depends on a number of factors, including the quality of the sperm, the wife's age, the egg activation process, and the egg damage rate.

        5. After ICSI, how long does it take for fertilization to occur?

          After the eggs have been inseminated (IVF or ICSI), the fertilization process occurs overnight. A first examination of the eggs is conducted in the morning, followed by a second examination later in the day. “Normal fertilization” of an egg is confirmed by the presence of a “nucleus” from the egg and another “nucleus” from the sperm.

        6. Are there any additional tests required for ICSI?

          The most common tests are additional sperm tests, and if sperm production is problematic, a testicular biopsy is recommended (when a small piece of testicular tissue is removed). It may be necessary to reassess hormone levels through blood tests.

          In some cases, couples will need genetic testing to determine the likelihood of passing an inheritable condition to their children. It is particularly important for men with inferior sperm characteristics, as genetic defects can cause these problems.

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