Intracytoplasmic sperm injection (ICSI) involves the direct injectionof sperm into eggs obtained from in vitro fertilization(IVF).
How is ICSI performed?
There are basically five simple steps to ICSI which include the following:
- 1. The mature egg is held with a specialized pipette.
- 2. A very delicate, sharp, and hollow needle is used to immobilizeand pick up a single sperm.
- 3. The needle is then carefully inserted through the shell of the egg andinto the cytoplasm of the egg.
- 4. The sperm is injected into the cytoplasm, and the needle is carefullyremoved.
- 5. The eggs are checked the following day for evidence of normalfertilization.
Once the steps of ICSI are complete and fertilization is successful,the embryo transfer procedure isused to physically place the embryo in the woman’s uterus. Then itis a matter of watching for early pregnancysymptoms. The fertility specialist may use a blood test or ultrasoundto determine if implantation and pregnancy has occurred.
Are there specific situations where ICSI might be recommended?
ICSI may be recommended when there is a reason to suspect that achievingfertilization may be difficult. ICSI is most often used with couples whoare dealing with male infertility factors. Male infertility factors caninclude any of the following: low sperm counts, poor motility or movementof the sperm, poor sperm quality, sperm that lack the ability to penetratean egg or azoospermia.
Azoospermia is a condition where there is no sperm in the male’sejaculation. There are two types of azoospermia: obstructive and non-obstructive.Obstructive azoospermia may be caused by any of the following:
- Previous vasectomy
- Congenital absence of vas
- Scarring from prior infections
Non-obstructive azoospermia occurs when a defective testicle is not producingsperm.
How is sperm retrieved for use in ICSI?
For men who have low sperm count or sperm with low mobility, the spermmay be collected through normal ejaculation. If the man has had a vasectomy,the microsurgical vasectomy reversal is the most cost-effective option forrestoring fertility.
Needle aspiration or microsurgical sperm retrieval are good alternativeswhen a competent microsurgical vasectomy reversal has failed, or when theman refuses surgery. Needle aspiration allows physicians to easily and quicklyobtain adequate numbers of sperm for the ICSI procedure. A tiny needle isused to extract sperm directly from the testis.
Needle aspiration is a simpleprocedure performed under sedation with minimal discomfort; however, thereis the potential for pain and swelling afterwards. The sperm obtained fromtestis is only appropriate for ICSI procedures when testicular sperm isnot able to penetrate an egg by itself.
What health concerns are there when considering ICSI?
There have been studies indicating that developing babies from pregnanciesachieved through artificial insemination, and particularly ICSI, may facean increased risk for some birth defects, such as imprinting defects. Imprintingrefers to the phenomenon in which certain genes function differently dependingon whether they involve a particular chromosome passed on by the fatheror by the mother. Reproductive researchers are concerned that manipulationof either gametes or zygotes may affect the imprinting process or the subsequentrelease. Other researchers believe that the incidence of these birth defectsoccurring is similar to those achieving pregnancy without ART proceduresand therefore should not be a deterrent in using them. The potential risksor complications from doing ICSI is something that you should discuss withyour reproductive specialist at length about.
Compiled using information from the following sources:
RESOLVE: The National Infertility Association, http://www.resolve.org
American Society for Reproductive Medicine (ASRM), http://www.asrm.org