ICSI - Is It For Us?
Before taking this important decision, you must ask yourself a few questions as a couple:
- Does the male partner have a low sperm count?
- Is the motility of the sperm exceptionally low?
- Are the sperm cells morphologically sound?
- Is the male partner vasectomised?
- Does the male partner experience trouble achieving erections or ejaculating?
- Does the male partner have diabetes, spinal cord injury or any other reproductively debilitating problems?
If yes, then ICSI might just be the solution you're looking for.
How Does the ICSI Procedure Work ?
ICSI works almost exactly like the IVF procedure, except the fertilization process. In IVF the fertilization process happens in a disc but in ICSI the sperm is injected in the egg individually using a machine called micromanipulator.
Intra Cytoplasmic Sperm Injection
Until the 90's males with very low counts (less than 5 million per ml) or poor quality sperms had no hope of fathering children. This problem was surmounted by the new breakthrough of ICSI, which took place in Brussels, Belgium in 1992.
Since then, many such patients have fathered a child. Our Team started our own ICSI programme in 1995-96 and have performed till date more than 1000 cycles with success rate of 30 to 40%, which is comparable to the best units in the world.
In ICSI all the steps are similar to the procedure of IVF, except the step of fertilization. Normally in IVF one egg is mixed with 100,000 sperms and one of the sperms fertilizes the egg on its own. In contrast, in ICSI each egg is held and injected with a single live sperm. This micro-fertilization is done with the help of a machine called the Micromanipulator.
Our clinic deals in Infertility treatment which includes ICSI treatment
What Are The Steps Leading Up To ICSI?
For women :
- Fertility drugs like gonadotrophin are administered.
- The eggs are collected
- Collected eggs are injected with healthy, washed and highly potent sperm and left to be fertilised at low temperature.
For men,the steps are:
- Sperm examination to determine suitability for fertilization.
- If suitable sperm is available; a sample is taken the natural way and individual sperm cells are injected into the egg.
- If not sperm is extracted directly using a micro syringe the epydidymis (a narrow tube inside the scrotum). This method is called PESA (percutaneous epididymal sperm aspiration). Other methods are TESA-testicular sperm aspiration, and TESE
What Are The Success Rates In ICSI?
After doing more than 800 of these ICSI Procedures here at IVF clinics run all over India by Dr. Nandita Palshetkar the success rates have been determined as 40% which is an injection of much needed hope indeed!
Thus the procedure consists of:
- Controlled Ovarian stimulation with drugs (GnRH Analogues and Gonadotrophins) to produce many eggs.
- Monitoring of follicles and egg development with the aid of vaginal sonography and serial Estradiol hormone estimation.
- Administration of hCG injection, (Human Chorionic Gonadotrophins) when the two leading follicles are 18mm in diameter.
- Oocyte or egg retrieval under short general anesthesia 35 to 37 hours after HCG injection.
- Identification and isolation of eggs in the laboratory.
- Sperm collection and processing in the lab. Incase of azoospermia (no sperms in the semen) the sperms are collected directly from the testis with the procedures of PESA/MESA/FTNB/TESE or TESA.
- Dissection of the eggs in the laboratory with the help of an enzyme called Hyloronetis. Placement of eggs into small droplets of culture media under oil.
- Placement of sperms into small droplets of PVP under oil. Immobilization of the sperm with a micro-injection needle (Diameter of 7 microns) and aspiration of the immobile sperm into the needle (tail first).
- Holding the egg with a holding pipette and injection of the immobilized sperm into the held egg Placement of these eggs into the incubator for 2 to 5 days.
- Embryo formation 2 to 5 days after fertilization.
- Embryo transfer of good quality embryos back to the womb, after 2 (four cell embryo), 3 (six-eight cell embryo)or 5(blastocyst stage) days after egg removal.
- Males with severe sperm factors such as low count (less than 5 million), very poor motility or high degree of abnormal sperms.
- Males with azozoospermia, where there is no sperm present in the semen. The azozoospermia may be of the obstructive type where there is production of sperms in the testis but blockage of the conduction system which brings the sperm out into the semen. Alternately, the azoospermia may be of the non-obstructive type, where there is a failure of the testis to produce sperms. Nowadays, in both these types of azoospermia, sperms can be isolated directly from the testis, using the SPERM
- Retrieval Techniques of PESA/TESA/TESE and subsequently, ICSI can be performed on:
- Males with anti sperm anti-bodies.
- Males with ejaculated dysfunction due to spinal cord injury or malfunction such as quadriplegics or paraplegics.
- Patients with retrograde ejaculation (ejaculation of the sperm into the urinary bladder) who fail to become pregnant with IUI.
- Patients where fertilization has failed with In Vitro Fertilization.
In our unit we also believe in doing ICSI on patients who have had previous history of tuberculosis or endometriosis as we believe it gives better fertilization rates than standard IVF (this is a personal experience not supported by international literature).
Nowadays, some units are advocating routine ICSI for all patients, including those with normal sperm counts. We do not believe in such practice as we feel that pregnancy should be achieved with minimum handling of the gametes outside the body. If the sperm count is good enough for fertilization with IVF, we will not do ICSI. However, if a particular patient has a sperm count which is in the grey-zone area, then we may subject half the eggs to IVF and half the eggs to ICSI.