Intracytoplasmic Sperm Injection (ICSI) – Who need it, Procedure, Advantages and Risks

Overview 

Intracytoplasmic Sperm Injection (ICSI) is a treatment for infertility that involves the injection of live sperm into a woman’s egg in a laboratory. This process may create an embryo (fertilized egg). ICSI is a kind of in vitro fertilization (IVF) that doctors use commonly when male infertility affects a person’s ability to conceive a child.

Who are the people who require Intracytoplasmic Sperm Injection (ICSI)?

Intracytoplasmic Sperm Injection(ICSI) can be very helpful for people who are experiencing male infertility. The doctor can recommend ICSI when a person has:

1. Anejaculation (lack of ability to ejaculate)
2. Blockage in the male reproductive system
3. Low sperm count
4. Low sperm quality
5. Retrograde ejaculation (a condition where semen flows backwards into the bladder) 

People may also require ICSI if:

1. Traditional IVF has been successful
2. The person who provides the eggs is over 35 years of age
3. People are using previously frozen eggs or sperm (cryopreservation) to try to conceive 

What is the Procedure for Intracytoplasmic Sperm Injection (ICSI)?

Before the procedure

Prior to Intracytoplasmic sperm injection (ICSI), the doctor should collect eggs and sperm.

The following steps are done to retrieve the eggs:

1. Ovulation induction: the person who provides the eggs receives medication injections for eight to 14 days. This stimulates the ovaries to have several eggs mature simultaneously. Then, a Lupron injection or human chorionic gonadotropin (hCG) is given, which aids in the final maturation of the eggs.
2. Egg retrieval: the doctor uses transvaginal ultrasound technology to retrieve the eggs from the ovaries. In the ICSI process, a tiny needle, called a micropipette, is used to inject a single sperm into the center of the egg. With either traditional IVF or ICSI, once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 1 to 5 days before it is transferred to the woman’s uterus (womb).

Unless people use frozen sperm, the sperm collection will take place the same day as the egg retrieval. The person who provides the sperm:

• Avoids sex and masturbation (no ejaculation) two to three days before the sperm collection
• Masturbates at home or in a private room at a fertility clinic and collects the discharge in a container provided by the lab. The laboratory must receive the sample within 60 minutes from ejaculation.

Semen analysis is done immediately to examine the volume, mobility, and quality of the sperm. People experiencing azoospermia, anejaculation, or retrograde ejaculation can require a procedure for the collection of sperm. This also applies to those who have had an unsuccessful vasectomy reversal. Procedures such as electroejaculation and microscopic testicular sperm extraction can take place A laboratory would freeze and store the sperm (sperm bank) for later IVF use at the clinic.

During the procedure 

During ICSI, the doctor: 

1. Will use a small glass tube with a suction bulb to hold the mature egg in place on the lab dish.
2. Then the doctor pick up one sperm with the help of a thin needle.
3. Afterwards, they will place the needle into the egg to reach the cytoplasm.
4. They will then inject the sperm into the cytoplasm.
5. Finally, the needle is removed from the egg.

After the procedure 

After ICSI, the doctor will observe the fertilized egg in the laboratory to look out for signs of successful fertilization. A healthy fertilized egg must divide into cells in five to six days and form a blastocyst. The doctor will assess the size and cell mass of the blastocyst, to decide when it’s most likely to result in a pregnancy.

 An embryo transfer will happen on the fifth or sixth day after the egg retrieval procedure or generally, the transfer is delayed by a month or even years. The doctor will discuss with patients, the timing of the embryo transfer. With the help of ultrasound technology, the doctor places a catheter into the vagina and injects the embryo into the uterus. In order for pregnancy to occur, the embryo must be attached to the uterus. The doctor will advise waiting at least two weeks before taking a pregnancy test.

What are the advantages of intracytoplasmic sperm injection?

As compared to traditional IVF, ICIS seems to be more successful in assisting those experiencing male infertility to become parents. 

What are the risks of ICSI?

The following risks can occur with ICSI:

1. Damage to some or all the eggs when the needle is inserted
2. The egg does not fertilize after the sperm injection
3. The embryo stops developing in the lab or after embryo transfer

Conclusion

When people are having trouble conceiving a child, the doctor can advise ICSI. This procedure  is most helpful when there is a complication resulting in male infertility. People must speak to the doctor if ICSI is the right fertility treatment for them.