When some complex issues become the reason for your infertility, advanced technologies like ICSI become a ray of hope. All these fertility treatment options have a single goal, that is to achieve a healthy pregnancy. Long back when ICSI was not invented, male infertility due to low sperm count was considered untreatable. The ICSI procedure has enabled many couples who were unable to conceive or were dependent on donor sperm, to conceive their biological child through IVF.

Intracytoplasmic sperm injection (ICSI) is a conventional IVF procedure where fertilization of the egg is achieved through a different approach. Generally, fertilization occurs when a sperm attaches itself to the egg and penetrates through the outer layer. For some reason, the sperm may fail to penetrate the egg. In such a condition, ICSI can be done along with IVF to achieve pregnancy. During ICSI, a single sperm is picked and is injected directly into the egg.

ICSI is performed by an experienced embryologist using specialized instruments. Though ICSI is a precise procedure but still for fertilization to occur, required cellular events need to take place.

How ICSI Differs from Standard IVF Procedure?

In IVF, an egg can be fertilized in two ways; traditional and ICSI. In the traditional procedure, more than 50,000 sperms are placed close to an egg in a laboratory dish. Here fertilization occurs when a sperm penetrates and enters the cytoplasm of an egg. In ICSI, a small needle called a micropipette is used for injecting the sperm directly into the egg. In both cases, once the fertilization occurs, the embryo is allowed to grow in the lab for one to five days, then is transferred to a woman’s uterus.

Specific Situations where ICSI Treatment is Recommended

ICSI is a part of the IVF cycle, and it includes the same steps as IVF. When it is difficult to achieve fertilization or when male infertility is the real cause of infertility, ICSI is recommended. ICSI is advised only when the sperm can not fertilize the egg by itself.

Circumstances, where ICSI is recommended, includes;

• If your male partner is producing few sperms which may not result in a successful IVF

• If sperm motility is low

• The inability of the sperm to attach to an egg

• Blockade in the male reproductive system which needs surgical retrieval of sperms

• When there is a failure of the previous traditional IVF procedure

• Unexplained infertility

The decision to opt for ICSI is difficult, but it definitely increases the chances of fertilization. When you have unexplained infertility or failure of fertilization in previous IVF, the ICSI procedure can bring success.

ICSI Procedure/Technique

ICSI procedure is complicated and is performed by a skilled embryologist. It is done along with IVF in a laboratory.

Sperm retrieval

Firstly, the sperms need to be collected from the male partner. During low sperm count, it can be done through normal ejaculation. When this is not possible, needle aspiration or microsurgical sperm retrieval is performed. It is an easy and quick procedure where a tiny needle is used to extract the sperms directly from the testes. This procedure is performed under sedation and you might feel minimal discomfort. Post-procedure, you might experience pain and swelling.

Collecting the eggs

Women will be given fertility medication to produce several matured eggs. These eggs are retrieved from the vagina using vaginal ultrasound, under anesthesia, and then incubated in the laboratory in precise conditions.

The steps of ICSI procedure -

1. A matured sperm is retrieved in a specialized pipette.

2. A delicate and thin needle is used to immobilize and pick a sperm.

3. The needle is then used to insert the sperm into the cytoplasm of the egg.

4. After injecting the sperm, the needle is carefully removed.

5. The next day eggs are checked for fertilization.

Once fertilization occurs, the ICSI procedure is complete. The next step involves transferring the embryo to the woman’s uterus in two to five days. You will wait for two weeks to take a pregnancy test. Your fertility doctor will do blood tests and ultrasound to confirm pregnancy and if implantation has occurred normally.

How long does it take?

Normally it will take four to six weeks to complete one cycle of ICSI. You and your partner will be asked to stay for half a day in the hospital for egg and sperm retrieval process. After three to five days, you will be called for embryo transfer. If embryo transfer is planned next month or with a fresh cycle, then you will be called accordingly.

Success Rate of ICSI

The success rate of ICSI varies with every case, and particularly it is the fertilization achieved by ICSI. Generally, 70 to 80 % of the eggs get fertilized by ICSI. Success rates are similar to IVF performed in a traditional way. On average, 25% of success is seen in couples opting for ICSI.

Risks or Probable Health Concerns

When you get pregnant naturally, there is a 1.5% to 3% chance of a major birth defect in the baby. When it comes to ICSI, the chances of some birth defects is similar to IVF but slightly higher than the natural conception. Also, this defect may actually be due to the cause of infertility and not due to the treatment procedure.

There are some chromosomal abnormalities associated with ICSI, but it may be seen in less than 1% of children. There appears no difference in the embryo quality achieved through ICSI or normal IVF.

What to expect

ICSI procedure for treating infertility can be demanding both physically and emotionally, especially for a woman. Once conceived, you may have to take regular medications, injections, and have to undergo regular blood tests to maintain a healthy pregnancy. Sometimes it becomes painful or uncomfortable, and as we know, even during normal pregnancy, we face many physical challenges.

Bottom Line

ICSI is a complex procedure and is performed by specially trained embryologists. During severe male infertility, ICSI significantly increases the chances of pregnancy. Whether you have low sperm count or ejaculation problems, by discussing with your fertility doctor, you can understand the treatment procedures available to solve such issues.

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