Fertility Treatments

ICSI

Intracytoplasmic Sperm Injection, ICSI It is a procedure in which a sperm cell is directly injected into the egg to fertilise it.

Introduction

ICSI. It is a common medical procedure, and if you are a fertility patient, you probably know its basics. In layman’s terms, the egg is fertilised with a sperm cell directly injected into it. The doctor may suggest this procedure as the IVF fertilisation rates through this technique are much better than other techniques. But there’s much more to Intracytoplasmic Sperm Injection or ICSI than just the fertilisation rates. 

It’s all about increasing the chances of pregnancy by identifying the best sperm to improve fertility rates. In addition, it may help address some of the egg-related issues you may be facing. Thanks to the latest technological advancements, this technique has evolved impressively over the past few years. The method mainly focuses on selecting the best quality sperm to improve the IVF results. But you may want to have a thorough consultation with your fertility doctor to determine if the ICSI technique is suitable for you. Based on your health and any underlying conditions, the doctor may recommend other techniques as well.

What Is ICSI?

Before it can fertilise the patient’s egg, the head of the man’s sperm must latch onto the egg’s outer layer. Once the sperm latches on, it will start pushing through the cytoplasm layer to initiate fertilisation. 

Every once in a while, for several reasons that include poor motility, the sperm may not be able to push through the layers of the egg. In that case, the surgeon may opt for a procedure known as intracytoplasmic sperm injection or ICSI with IVF or in vitro fertilisation for the fertilisation of your eggs. As mentioned before, the doctor injects a single sperm directly into the centre of your egg’s cytoplasm. 

The ICSI technique is considered helpful to couples experiencing severe male factor infertility, or their previous attempts of IVF have not provided fruitful results. Several barriers and hindrances presented by the IVF can be overcome by the ICSI procedure, offering the couples wanting pregnancy that sliver of hope they have been looking for. In addition, with this technique, they can have fertilised embryos. 

In this procedure, the patient may be required to go through an ovarian stimulation with the help of fertility medicines to develop several mature eggs. These eggs are then drawn out using vaginal ultrasound to be kept under suitable conditions in a fertility laboratory for incubation. Meanwhile, the doctor prepares the sperm sample using a centrifuge to separate the healthy sperm from dead ones and debris. Then, as mentioned before, the embryologist injects the healthy sperm directly into the eggs to prepare the embryo. 

PICSI, or physiological intracytoplasmic sperm injection, is an advanced form of ICSI which uses a functional test to determine the healthiest sperm to make the fertilisation more successful. In this test, the sperm that binds or latches properly onto the hyaluron (to mimic the sperm latching on the egg) is separated from the rest to be further processed for ICSI. 

If you have not had successful ICSI previously or your sperm has lower motility, you may benefit from PICSI.

How Does ICSI Work?

First off, during a standard IVF cycle, the doctor will retrieve mature eggs from the female partner to carry out the ICSI. The doctor will then remove the outer layer or cumulus from every egg to ensure that it is ready and mature to be processed through intracytoplasmic sperm injection. The doctor won’t inject any immature eggs, but they may be incubated for a few hours to be reexamined later. If they become mature enough, they will be processed for the ICSI with the other healthy eggs. You will be notified the next day about how many eggs were matured and how many were inseminated. 

Meanwhile, the doctor will also process the male semen to separate the healthy and motile sperm from the dead ones and debris. The motile sperm cells are injected based on their shape or morphology, but this process may not reflect their ability to fertilise the egg. 

You may not be able to observe the egg with the naked eye, so it is held with an instrument called a holding pipette. Then, a needle-like glass instrument picks up a single sperm and gently inserts it through the outer layer into the egg. 

Afterwards, these eggs are kept inside an incubator for the night to check for fertilisation the next day, and you will know how many have been divided into embryos after 24 hours. But you may need to understand that not all eggs will develop into embryos. It will depend on various factors, including the woman’s age and her medical history. The additional embryos may be stored for future use.

Do I Need ICSI?

If you are a couple experiencing male fertility issues such as low sperm motility and morphology, low sperm count, anti-sperm antibodies, or have had a vasectomy, you may be the perfect candidate for intracytoplasmic sperm injection. 

But it may also be used if the couple is facing fertility-related issues such as:

  • The male sperm moves bizarrely.
  • An issue with the male reproductive tract blocking the sperm. 
  • Eggs being used are the in vitro matured ones.
  • Sperm count is too low for artificial techniques like IUI and IVF. 
  • Sperm are having issues latching on to the egg.
  • Irrespective of the condition of the sperm, the eggs have not been fertilised by IVF.
  • Eggs being used have previously been frozen.

 

If you are a couple experiencing any of these issues, the doctor may recommend IVF combined with ICSI to ensure that you conceive a beautiful and healthy baby.

What Are The Benefits Of PICSI?

Naturally, the sperm encounters HA or hyaluron in the cervix’s mucus and the egg’s surrounding cumulus matrix. Therefore, one of the significant parts of successful fertilisation is an effective penetration of sperm in vitro into the cumulus matrix and cervical mucus. The process will also decide the fate of the forthcoming embryo implantation. Hyaluron is one of the significant parts of this process. 

So PICSI exploits this natural encounter and helps the embryologist select an HA-constrained sperm to be injected. By separating and selecting this constrained sperm for intracytoplasmic sperm injection, the doctor automatically has initiated the procedure with the help of more mature and better-quality sperm. This kind of sperm is less likely to experience DNA damage, along with a usual chromosome complement. Although there is no visible difference between the different stages of the fertilised eggs, they will develop better through day 3 to day 5. But the probability of pregnancy will be much higher when the eggs are in their day 5 to 7 stages. 

As mentioned earlier, the fertility will also depend upon the woman’s age, initial semen analysis, diagnosis, etc. the specialist will discuss these factors with you during the consultation.

Are There Any Risks To The Child?

Thousands of children are born with the help of ICSI and other artificial fertilisation techniques around the world. So far, the experts have not observed any significant difference concerning congenital disabilities between the children born with ICSI and IVF and those born naturally. 

But some of the factors that may decide the presence of complications are a woman’s age during pregnancy, genetic history, any pregnancy complications with the patient. It is also possible for a male child to have fertility issues if the father had them during conception.

Some men may have issues other than hereditary issues, like a spinal cord injury or vasectomy. But some may even have congenital sperm issues, and they may transfer on to the child as well. Also, the child may inherit cystic fibrosis or CF gene due to the father having an obstruction in their sperm ducts. 

If a mother has issues while giving birth or the man has a lower sperm count, a male child may have an abnormal number of sex chromosomes. Although they may be pretty normal in appearance, these children may be infertile or have behavioural issues. 

For a woman getting pregnant naturally, their child’s probability of a congenital disability is around 1.5% to 3%. For children born with ICSI, the likelihood of birth defects will be almost equal to IVF but will be slightly higher than natural birth. But, as mentioned before, the difference is not significant. Some children may face the same fertility issues as their fathers.

What If ICSI Fails?

The oocyte activation issue may be one of the primary reasons behind couples not getting pregnant even after ICSI. Although ICSI is the last resort of a technique for pregnancy, if the problem is related to oocyte activation, nuclear transfer technology may be the answer. But there isn’t enough research and evidence available to suggest that nuclear transfer technology is the approach beyond ICSI. 

You may want to get in touch with the experts at Siya Health to understand if these technologies will help you conceive.

Conclusion

Since the ICSI or intracytoplasmic sperm injection was introduced in 1992, the use of donor sperm has decreased quite considerably. However, thanks to this technique, over 95% of fathers have been able to parent a child with their sperm. Thus, ICSI has been quite a revolution since IVF was first introduced. 

The success of ICSI with IVF depends on several factors, so its results aren’t quite comprehensible. Other than natural factors, the success of this technique will also depend on the skills of the doctor and embryologist and the quality of the lab. 

Please consult the Fertility experts at Siya Health, or call our Siya Fertility Counsellor today, if you are looking for successful fertilisation through ICSI.

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Dr. Dipesh Sorathiya

M.S. (Obs & Gyn)
DIP. in Gynec Endoscopy (CICE)

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