Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection (ICSI) is a procedure during which a sperm is directly injected into an egg during in vitro fertilization (IVF). The fertilized egg is then grown in a laboratory for a few days before it is implanted directly into the woman’s uterus. With ICSI, only a single healthy sperm is needed for each egg. This procedure is often performed to increase the chances that fertilization will take place in cases where the sperm count is low or the sperm cannot penetrate the cytoplasm (outer layer) of the egg.
Candidates for ICSI
Many couples consider intracytoplasmic sperm injection after past attempts at becoming pregnant have been unsuccessful. The ICSI procedure is often performed to treat a variety of infertility issues that may include:
- Male partner with low sperm count
- Blockages in the male reproductive tract
- Sperm which are shaped incorrectly
- Sperm incapable of penetrating an egg
- Unreceptive or abnormal eggs
In some cases, couples may consider the ICSI procedure after traditional IVF treatment has been unsuccessful
The ICSI Process
Prior to the ICSI procedure, ovulation induction treatments are usually performed to produce multiple eggs. During the ICSI, the eggs are collected from the ovaries through a needle which is guided through the abdomen using ultrasound technology. Sperm are also collected for fertilization. The sperm may be produced by a normal ejaculation, may be extracted surgically, or may be donated by a sperm donor. The semen is centrifuged to separate active sperm from inactive sperm and seminal fluid. The active sperm are then tested for motility, shape concentration, and volume. Once the active sperm have been washed to remove any toxic chemicals, one sperm is injected into each egg and incubated in the lab for 1 to 5 days. The fertilized eggs are evaluated for viability, and two to four of the likeliest candidates are implanted into the uterus using a catheter. Hopefully, one of the fertilized eggs will attach itself to the uterus for pregnancy. The remaining fertilized embryos may be cryopreserved (frozen) for future IVF attempts. ICSI is performed as an outpatient procedure, however following the embryo transfer, the patient must rest in bed for several hours before discharge. Two weeks after the embryo transfer, the physician will perform a pregnancy test. Women may require regular blood tests, progesterone injections and continued monitoring after ICSI insemination.
Risks of ICSI
Risk factors for ICSI are similar to those of IVF procedures. These include the risk of multiple births, and the risk of ovarian hyper stimulation syndrome. Risks associated specifically with the ICSI procedure may include damage to the eggs harvested, eggs that do not grow into embryos even after sperm have been injected, and growth problems with the embryos themselves.
Factors that diminish the success rate of ICSI may include:
- Advanced age of male or female partner
- Poor egg quality
- Poor sperm quality
- Prolonged infertility issues
- Female reproductive problems, such as endometriosis
When ICSI is used in combination with in vitro fertilization and eggs of good quality, it is often a successful treatment for men who have impaired sperm or low sperm count. Freshly fertilizes eggs have a greater chance of success with ICSI than cryopreserved eggs. Ethical and legal concerns of IVF may also accompany ICSI. Many couples may experience physical and psychological stress during infertility treatments, which can be costly, and may not be covered by insurance. The couple should discuss all fertility treatment options with a physician to determine the best approach in their particular case.