Before a man's sperm can fertilize a woman's egg, the head of the sperm has to attach to the outside of the egg. Then it pushes through the outer layer of the egg to the inside of the egg (cytoplasm). Sometimes the sperm cannot penetrate the outer layer. A procedure called intracytoplasmic sperm injection (ICSI) can help fertilize the egg by injecting the sperm directly into the egg.

 

ICSI is an acronym for intracytoplasmic sperm injection - which is a long, fancy way of saying "inject sperm into the middle of the egg". ICSI is a very effective method to get fertilization of eggs in the IVF lab after they have been retrieved from the female partner.

 

IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and then pick up individual sperms in a tiny specially designed hollow ICSI needle. Then the needle is carefully advanced through the outer shell of the egg and egg membrane and the sperm is then injected into the inner part (cytoplasm) of the egg. This will usually result in normal fertilization in approximately 70-85% of eggs injected with viable sperm. First, the woman must be stimulated with medications and have an egg retrieval procedure so that we can obtain several eggs in order to attempt in vitro fertilization and ICSI.

 

 

How ICSI works

In traditional IVF, the sperm are mixed with the woman's egg in a laboratory. If ICSI is needed, a small needle is used to inject a sperm into the center of the egg. The fertilized egg grows in a laboratory for one to five days, then it is placed in the woman's uterus (womb).

 

 

Who would need ICSI?

ICSI helps to overcome a man's fertility problems, for instance:

• Too few sperm are produced

• Sperm may be not be shaped correctly or move in a normal fashion

• The sperm may have trouble attaching to the egg

• A blockage in the reproductive tract keeps sperm from getting out. In this instance sperm can be retrieved from the epididymis or testis by microscopic surgery

ICSI can also be used when the use of traditional IVF has not produced fertilization, regardless of the condition of the sperm.

 

 

ICSI and baby's development

If a woman gets pregnant naturally, there is a 1.5% to 3% chance that the baby will have a major birth defect. The chance of birth defects after ICSI are rare. Certain conditions that have been associated with the use of ICSI (Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, or sex chromosome abnormalities) are thought to occur in far less than 1% of children conceived using this technique. Some of the problems that caused your infertility may be genetic. Therefore, boys conceived with the use of ICSI may have infertility issues as adults.

 

 

Fertilization and pregnancy success rates with ICSI

Fertilization rates for ICSI: Most IVF programs see that about 70-85% of eggs injected using ICSI become fertilized. We call this the fertilization rate, which is different from the pregnancy rate.

Pregnancy success rates for in vitro fertilization procedures with ICSI have been shown in some studies to be higher than for IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quantity and quality) as compared to some of the women having IVF for reasons other than male factor infertility. Another way to say this is - average egg quantity and quality is usually better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs - as compared to cases with unexplained infertility in which there is more probability of a somewhat reduced egg quantity and quality (on the average, since some women in this group have egg related issues).

ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician performing the procedure.

Sometimes IVF with ICSI is done for "egg factor" cases - low ovarian reserve situations. This is when there is either a low number of eggs, or lower "quality" eggs (or often both). In such cases, ICSI fertilization and pregnancy success rates are somewhat lower (as a group) since the main determinant of IVF success is the quality of the transferred embryos - and the quality of the eggs is the most crucial factor determining the quality and viability of the resulting embryo.

 

 

 

 

 

 

 

 

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