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What is ICSI (INTRACYTOPLASMIC SPERM INJECTION)

Author Name: Dr. Pooja Verma Mentor Name: Dr. Naveena Singh on April 08, 2020

INTRACYTOPLASMIC SPERM INJECTION

In vitro fertilization is type of assisted reproductive technology in which eggs are removed from the body and fertilization is done outside the body. It is of two type

1. Standard insemination or classical IVF
2. Intra-cytoplasmic sperm injection

i. In past, based on the sperm quality, in standard insemination or classical IVF procedure, around 50 thousand to 1 lac sperm are left with egg for fertilization. In this procedure, penetration of egg by sperm is done by natural process which may or may not result in fertilization.

ii. After the introduction of ICSI in 1992, it became the first choice for male sub-fertility or infertility. Pregnancy can be achieved successfully by this procedure not only in cases with poor quality of sperm in ejaculated sample, even with sperms retrieved from testicular biopsy or from epididymis.

ICSI: –

It is micro manipulative technique in which single spermatid(sperm) is injected in the center of a single mature egg(oocyte) cytoplasm with very fine needle called micropipette.

Indications:-

It is blessing and necessary for male factor infertility with abnormal or borderline semen analysis. However it is also recommended to maximize success rate of IVF procedure.

  • Low sperm count (oligospermia)
  • Poor motility of sperm (asthenospermia)
  • Abnormal morphology of sperm (teratospermia)
  • Obstructive azoospermia, (prior infection ,congenital absence of bilateral vas deferens, post-vasectomy)
  • Erectile dysfunction
  • Retrograde ejaculation
  • Failed IVF cycle
  • Anti-sperm antibodies.
  • Unexplained infertility.
  • For couples planned for PGT-A and PGT-M.
  • Fertilization of cryopreserved egg (To overcome harden outer shell of egg).
  • Sperm with high DNA fragmentation.
  • For frozen sperm in cancer patient.
  • Low ovarian reserve

Success rate:-

Success rate of ICSI, for male factor infertility, is much more than conventional IVF, which is around 75-80% fertilization rate.
• However, success does not only depends upon the technique of procedure performed but also on the equipment used, sperm quality and egg quality.

Procedure: –

• It involves the stimulation of ovary by giving hormonal injection.
• Growth and maturation of follicle is monitored by doing an ultrasound.
• After appropriate growth, eggs are retrieved from ovary with help of specialized ultrasound-guided needle.

Semen sample preparation:
Semen sample preparation for fertilization procedure depends upon the quality and quantity of sperms in the sample as well as from the source of collection (ejaculate / surgical retrieval)

• On the day eggs are taken out from ovaries (ovum pickup), male partner needs to collect semen sample either by masturbation or sperms are surgically retrieved from testicular biopsy (TESE/TESA, PESA) as per case history.

• Semen sample or sperms collected are prepared in andrology/ embryology laboratory by different sperm preparation techniques, to get rid ofdebris and dead sperm and to separate healthy sperm.By this approach sperms are selected on the basis of visual assessment (by seeing normal morphology and motility).

Steps of procedure:

•One of the mature egg is held with a pipette for stabilization, keeping polar bodies at 12’o clock or 6’o clock position.
• Sperm is immobilized by hitting or injuring the tail.
• After thissingle sperm is injected in the center of egg cytoplasm by manually penetrating outer egg shell.
• In this process, acrosomal reaction is skipped which need to occur when sperm tries to penetrate an egg in natural fertilization, failure of which results in infertility.
• Fertilization should be checked 12-18 hour after the procedure.
• Embryos formed are usually assessed at day 3 or day 5 stage post fertilization.
• Depending upon the grading of embryos, fresh or frozen embryo transfer is done.
• If PGD (pre implantation genetic diagnosis) is indicated,then biopsy of embryo is done and it is examined for any chromosomal abnormality. And embryo with normal genetic constituents will be transferred thereafter.

Disadvantage OF ICSI:-

a) Egg may get damage during handling for procedure
b) May result into poor embryo development
c) May cause fertilization failure.
d) Cost effectiveness (expensive than IVF)

Conclusion:-
ICSI is the most reliable and proven technique to prevent fertilization failure. It is the treatment of choice for all cases with male subfertility and infertility issues.

It’s proven with various research and studies that the chances of birth defect in a baby is almost same whether conceived naturally or by an IVF-ICSI procedure.

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