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Intra Cytoplasmic Injection(ICSI)
What is ICSI?
Intracytoplasmic injection or ICSI, involves the injection of a single sperm into a mature egg to achieve fertilization. It is primarily done when the sperms are of poor quality.
ICSI becomes a part of certain IVF cases. While the rest of the IVF process remains the same- maturation of eggs through hormones and collection of mature eggs- the difference comes during the fertilization step.
In a traditional IVF procedure, 1 egg and up to 100,000 sperm are placed in a petri dish. Fertilisation is achieved by natural processes involving changes to both sperm and egg.
During an ICSI, one good quality sperm is injected directly into the egg to increase the chances of embryo formation. The embryo is introduced into the womb during its blastocyst stage.
For which patients is ICSI recommended?
- Poor quality sperms
- Testicular sperms (TESA/TESE)
- Poor quality sperms post freezing
- Reduced or failed fertilization in a previous IVF cycle
- Low sperm count
- Reduced sperm mobility
- Abnormal sperms
- Sperms retrieved directly from the epididymis (PESA) or from the urine, or by electro ejaculation
- Post vasectomy
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Surgical interventions
In certain rare cases of male infertility, normal sperm production or sperm ejaculation is prevented by an obstruction in the complicated tubal system of the testes. To treat this, it is possible to retrieve sperm through surgical sperm retrieval. We use a very fine needle to extract sperm directly from the epididymis or the testes. But this can be done only if motile sperm are being produced. However, if we do not find any live sperm, we take a sample of tissue (testicular biopsy) from the testes and examine it under a microscope for sperm cells. Any surgically retrieved sperm cells can then be used to fertilise eggs through the routine ICSI.
Frequently Asked Questions
Not all eggs are of high quality. Hence, sometimes even good sperms do not lead to fertilization. However, on average 60-70% of eggs do achieve fertilisation irrespective of the sperm’s quality.
Typically, ICSI as a separate procedure does not have any risks. However, as it is used in conjunction with an IVF cycle, it involves the same possibilities, including multiple pregnancies.
We look for any signs of fertilization one day after the sperm is mixed with the egg. The next day, we check to see if the embryo has divided (cleaved). These are allowed to develop and thereby monitored in the laboratory until day 5 or 6. By then, nearly 40-50% of the embryos should reach the blastocyst stage.
