What is Intracytoplasmic Sperm Injection (ICSI)?

● The sperm head must attach to the outside of the egg before the sperm can fertilize the egg. In order to fertilize the egg, the sperm must penetrate the outer layer of the egg (cytoplasm) to reach the inside.

● A variety of reasons can prevent sperm from penetrating the outer layer. The sperm may be unable to swim because the egg's outer layer is thick or hard to penetrate. In these cases, intracytoplasmic sperm injection (ICSI) can be used along with in vitro fertilization (IVF) to fertilize the egg. ICSI involves injecting a single sperm directly into the egg's cytoplasm.

How does ICSI work?

● An egg may be fertilized by IVF in two ways: traditionally and through ICSI. Traditional IVF involves placing many swimming sperm next to an egg in a laboratory dish. When one of the sperm enters the cytoplasm of the egg, fertilization occurs. An ICSI procedure involves injecting a single sperm into an egg with a tiny needle. In either traditional IVF or ICSI, after fertilization, the fertilized egg (now called an embryo) grows in a laboratory for 1 to 5 days before being transferred into the uterus.

Who would need ICSI?

1. Severe male factor infertility- low sperm count / low motility

2. Surgically retrieved sperms

3. Female partner with very low ovarian reserve

4. Previous failed fertilization with IVF

5. Frozen thawed egg fertilization

6. Eggs with abnormalities like thick zona

7. IVM egg fertilization

8. Poor egg quality

9. Couple who want to get genetic sceeening of embryos ( to ensure better fertilization & ensure non-participating sperms donot influence diagnosis)

Steps for ICSI?

1. Evaluating the couple.

2. Planning individualised best stimulation protocol

3. Stimulating the ovaries with fertility medications ( gonadotropin injections with or without oral medications) for minimum of 8-12days to develop multiple mature eggs.

4. Monitoring the response to stimulation medication by serial ultrasound scans and hormonal blood tests.

5. Collecting the eggs under short anaesthesia by needle aspiration and ultrasound guidance via vaginal route ( no scar on abdomen / no pain / daycare procedure)

6. Male partner provides semen sample - by mastrubation/ surgical sperm retrieval method

7. Eggs collected are fertilized by injecting single male partners sperm into the egg by the senior embryologist.

8. The resulting fertilized egg called embryo is cultured for 3 to 5 days in special incubators to facilitate growth.

9. Genetic testing of embryos done if recommended after 5 days of development of embryos

1. Selection of 1 or 2 embryos for transfer to the female partners uterus. ( remaining embryos can be frozen for further use)

1. Supportive medication given for 2 weeks

1. Pregnancy test done after 2 weeks.

Advantages

1. High success rates

2. Best for male infertility management

3. One of the most advanced fertility treatments available