• Preparing the gametes (reproductive cells) for the obtention of embryos
• Delivering a single sperm to the egg cell in labratory settings
• Mostly used for overcoming sperm-related infertility
ICSI IN IRAN: ALL YOU NEED TO KNOW
Sperm disorders cause infertility in around half of the cases. ICSI or intracytoplasmic sperm injection seems to be a good choice for fixing this defect.
To fertilize an egg, the sperm attaches to the outer layer of the egg with its head and pushes through to enter the cytoplasm where fertilization occurs. However, sometimes the sperm can’t penetrate into the egg due to a variety of reasons such as low motility of sperm, sperm abnormality, and egg wall thickness and so on. In these cases, ICSI is applied in which a single sperm is injected into the egg’s cytoplasm directly.
The causes of ICSI
As mentioned are various causes of infertility in men and women. Due to any reason if the sperm cannot reach the ovum ICSI is suggested. Other causes may include:
• low sperm count
• Poor motility of sperm (abnormal movement)
•Abnormal morphology of sperm
• Unsuccessful IVF
• Anti-sperm antibodies
• Pregnancy after vasectomy
• Physical barriers such as a blockage in the male reproductive tract or thick egg wall
• Using frozen eggs (lower quality)
• Embryo testing to detect possible genetic problems (attached sperm to the egg wall, interfere with the test results).
Preparation of ICSI
ICSI consists of 6 steps:
• Stimulating ovaries to produce more eggs
• Retrieving eggs
• Retrieving sperms
• Injection of a single sperm into the eggs (fertilization)
• Transferring the healthy embryos to the uterine cavity
• Pregnancy test
In traditional IVF, sperm retrieval is done through the ejaculation sample on the same day of egg retrieval. However, if there is no sperm in the semen or if ejaculation is not possible, the doctor extracts the sperm in one of these ways:
• Percutaneous epididymal sperm aspiration (PESA) that is sperm extraction from epididymis under local anesthesia
• Testicular sperm aspiration (TESA) that is sperm extraction from testicle under local anesthesia
• Testicular sperm extraction (TESE) or micro-TESE if it is under the microscope in cases that earlier technique doesn’t remove enough sperms. In this method, the doctor takes a biopsy of the testicle, where there is a possibility of sperms attached to it. This procedure is done under general anesthesia.
In these conditions, the sperm is extracted before the cycle begins and sperm is frozen.
These tips are important for the ICSI process:
• It is strongly suggested to refrain from smoking and drinking.
• It is recommended to take in prescribed vitamins
• It is suggested to keep a diet that enhances fertility
• Make sure to get enough sleep
• It is advised to keep on breathing exercises to control and reduce stress.
Risks of ICSI
Associated risks to ICSI may include:
• A slight increase in the probability of infertility in male newborns (paternal factor)
• A slight increase in the chance of certain genetic and developmental defects such as sex chromosome abnormalities, hypospadias, and Angelman syndrome.
• Probability of embryo damage despite successful fertilization
• 30 to 35 percent chance for twins and 5 to 10 percent chance of multiple pregnancies
There is not a lot of evidence to have a certain conclusion about these matters. ICSI is a relatively novel technique accordingly experts are still learning about the best practices and possible effects. You may have genetic testing before the embryo implantation to confirm any possible congenital diseases.
What to expect from an ICSI?
ICSI is one of the common approaches of ART. In traditional fertilization, the eggs are exposed to more than 50,000 sperms in a laboratory petri-dish and one of them breaks through the egg wall and enters the cytoplasm. In ICSI, a single sperm is injected into the egg using a needle called the micropipette. This technique is called micromanipulation, which uses very small surgical tools. Then the fertilized egg grows for 1 to 5 days in the lab before being transferred to the uterus. Besides the fertilization process, the other steps are similar to traditional IVF. One ICSI cycle takes around 4 to 6 weeks to complete. Egg and sperm retrieval process are done for half a day, and you will be back 2 to 5 days later for embryo transfer.
The fertilization rate in ICSI is higher than traditional IVF, but the pregnancy rates are similar:
• 44% in women between 18 to 34
• 39% in women between 35 to 37
• 30% in women between 38 to 39
• 21% in women between 40 to 42
• 11% in women between 43 to 44
• 2% in women between over 45
Approximately 25% of women get pregnant in their first attempt. If you are over 40, you may be offered to do three full cycles of ICSI with two embryos in every cycle to increase the chance of pregnancy. The way of injection and the cell environment in the dish including the pH, osmolality, and temperature affects the success rate of the ICSI procedure. Therefore, it is very important to use well-known specialists to help you get pregnant.