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Intracytoplasmic Sperm Injection (ICSI) Treatment

Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat sperm related infertility problems. ICSI is used to enhance the fertilization phase of in vitro fertilization (IVF) by injecting a single sperm into a mature egg. The fertilized egg is then placed in a woman’s uterus or fallopian tube.

Importance

i)Intracytoplasmic sperm injection (ICSI) is used to treat severe male infertility, as when little or no sperm are ejaculated in the semen. Immature sperm collected from the testicles are usually unable to move about and are more likely to fertilize an egg through ICSI.

ii)Some couples may choose to try ICSI after repeated in vitro fertilization has been unsuccessful.

iii)ICSI is also used for couples who are planning to have genetic testing of the embryo to check for certain genetic disorders. ICSI uses only one sperm for each egg. So there is no chance the genetic test can be contaminated by other sperm.

INTRACYTOPLASMIC SPERM INJECTION (ICSI) TREATMENT

ICSI PROCEDURE

i) Sperm collection: Before collection of the sperm, the Male partner should be screened for possible genetic problems that could affect the offspring.

If the sperm cannot be collected by the means of masturbation, they must be surgically removed from a testicle through a small incision. This method of sperm retrieval is done when there is blockage that prevents sperm from being ejaculated or when there is a problem with sperm development.

ii) Ovulation and egg retrieval: The female partner should be injected with gonadotropin or follicle-stimulating hormone (FSH) to stimulate the ovaries to produce multiple eggs (superovulation).

After the first week, the doctor should check the blood estrogen levels and use ultrasound to see whether eggs are maturing in the follicles. During the second week, the dosage may change based on test results and ultrasound.
If follicles fully develop, the female partner is given a human chorionic gonadotropin (hCG) injection to stimulate the follicles to mature. The mature eggs should be collected 34 to 36 hours later using laparoscopy or needle aspiration guided by ultrasound through the abdomen to the ovaries.

iii) Sperm injection and transfer: Under high-power magnification, hold an egg in place with a glass tool (holding pipet). A microscopic glass tube containing sperm (injection pipet) is used to penetrate and deposit one sperm into the egg.
After culturing in the laboratory overnight, eggs are checked for evidence of fertilization. After incubation, the eggs that have been successfully fertilized (zygotes) or have had 3 to 5 days to further develop (zygotes or blastocysts) are selected.

Two to four are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix.
The remaining embryos may be frozen (cryopreserved) for future attempts.

Surgical Sperm Retrieval

Patients with certain ejaculatory disorders or no sperm in the ejaculate may be offered Surgical Sperm Retrieval and given a chance to father their own child (with an ICSI treatment cycle).

We offer the following types of SSR techniques:

  • Percutaneous Epididymal Sperm Aspiration (PESA)
  • Testicular Sperm Aspiration (TESA)
  • Testicular Sperm Extraction (TESE)

For PESA, a small number of sperm is obtained directly from the epididymis, which is the beginning of the outlet tube from the testicle.

If PESA is unsuccessful, TESA or TESE may be offered. In this procedure, the sperm is obtained directly from the testicle.

Indications for Surgical Sperm Retrieval are as follows:

  • Congenital bilateral absence of vas deferens
  • Obstruction of both ejaculatory ducts
  • Azoospermia
  • Failed vasovasostomy
  • Failed epididymovasostomy