Intracytoplasmic Sperm Injection (ICSI)
What is Intracytoplasmic Sperm Injection (ICSI)?
Intracytoplasmic Sperm Injection (ICSI) is a particular type of In Vitro Fertilisation (IVF) utilised by specialists in the treatment of severe cases of male factor infertility.
ICSI is a procedure that involves the injection of a single healthy sperm from a male, directly into a single healthy mature egg from a female.
How can ICSI help us?
This procedure means that the sperm doesn't have to complete the journey to the egg, or penetrate the outer layers of the egg. This is particularly useful for treatment of infertility where the sperm either can’t get to the egg, or can get to the egg, but cannot fertilise it for whatever reason.
Who is the ICSI procedure recommended for?
- Generally, couples who have had poor or no fertilisation during standard IVF treatment, and
- Males who have demonstrated and documented:
- Low sperm count;
- Obstruction(s) to sperm release (including vasectomy or injury);
- Antibodies to their own sperm (this is a condition which prevents normal sperm function);
- Problems with getting an erection and ejaculating (e.g. due to spinal cord injuries or disease),
- Poor sperm morphology (i.e. shape) or motility (i.e. speed and movement); or
- An unsuccessful vasectomy reversal procedure.
The potential improvement in fertility that the ICSI procedure may yield will be dependent upon a number of separate factors. These include such issues as the woman’s age, the couple’s overall diagnosis, and the initial male semen analysis. Please be assured that these factors, as well as risk/benefit issues will be discussed with you by your specialist prior to any treatment taking place, and you should be prepared to ask as many questions as you need to feel comfortable with proceeding.
An overview of ICSI. What will happen?
Prior to commencing the actual Intracytoplasmic Sperm Injection (ICSI), mature eggs must be collected from the female partner during a “standard” IVF cycle. This is achieved by stimulating the ovaries to produce eggs, using a powerful fertility drug. Immature eggs cannot be used in the ICSI procedure, but they can be incubated for a period of time (usually between 2 and 6 hours) and reassessed for appropriate maturity. If maturity is attained in that time, those eggs may also be used. Eggs “rest” for up to 3 hours following collection, and then the cumulus (or outer coating of cells) is physically taken away from each individual egg. At this stage, the eggs are considered mature enough to undergo the procedure of injection.
A semen sample is collected from the male partner, usually by ejaculating into a cup on the same day as the eggs are collected. However, if there is no sperm in the semen sample, it can be extracted directly from the epididymis (the tube that carries the sperm from the testicle to the penis), or the testicles themselves. This process takes longer and the procedure to collect sperm will be determined prior to the egg harvest.
The semen sample is then prepared in a laboratory, to identify and isolate the strong, healthy, and motile (or moving) sperm.
A special instrument is used to hold the egg in place for the sperm injection – but it is so small that you can’t see the tip of it with the naked eye! An even smaller, thinner, and sharper instrument is employed to select and transfer a single normal-appearing sperm. The needle is then inserted through the egg’s outer coating (called the zona pellucida) and into the egg itself, slowly injecting the sperm into the egg. The needle is withdrawn, leaving the sperm behind to fertilise the egg. This may be performed a number of times on multiple healthy, mature eggs with individual viable sperm.
All of the injected eggs are then incubated overnight to allow the process of fertilisation to begin. Signs of fertilisation should be apparent after this period of time, and an additional 24 hours will allow us to determine exactly how many eggs have been successfully fertilised, divided and progressed to form embryos.
It is important to understand that not all eggs successfully fertilise, and not all fertilised eggs become embryos, despite our best efforts and the health of the sperm and eggs.
In line with standard IVF treatment, the number of embryos placed into the uterus will depend on a number of factors, including the woman’s age and medical history. However, additional healthy embryos can be frozen for later use, if desired.
Risks can be broadly separated into two categories: risks to the unfertilised egg and risks to any resulting children (i.e. fertilised eggs and viable embryos).
- For the unfertilised egg, there is a small risk (less than 2%) that permanent damage to the egg may occur during the procedure, resulting in a non-viable egg. This is largely due to the invasive nature of the procedure overall, meaning that the egg is handled (albeit in a sterile laboratory environment) more than the standard IVF techniques for insemination.
- For the resulting child, there are minimal risks. There are thousands of children conceived and born as a direct result of ICSI, and to date, there is no convincing evidence that the incidence of birth defects is any different with ICSI or IVF as compared to those children born to parents of similar age and health. It is possible, however, that male children born as a result of ICSI might have a fertility problem, similar to his father or slightly different.
We know that the most important factors affecting newborn health relate to issues such as maternal age at delivery, family history and the presence of pregnancy complications. There may be a higher risk of certain congenital conditions (e.g. cerebral palsy), as the risk increases to about 6% after IVF or ICSI. It is also important to understand that this is still considered low risk.
Remember that the ICSI procedure means that we have circumvented certain biological processes that would usually screen out “weaker” sperm. The journey a sperm would normally make from ejaculation to meet a mature egg for fertilisation is a difficult one – they must travel great distances and break through the membrane of an egg in order to fertilise it. With ICSI, there is therefore an increased risk of rare genetic problems carried by weaker sperm being passed on to the child. Remember that these and other issues should and will be discussed with you before proceeding with any treatment.
Men with very low sperm counts have an increased risk of about 1%, of producing a son with an abnormal number of sex chromosomes (i.e. XXY or XYY instead of the usual XY). These boys have a normal physical appearance and are likely to have normal IQ scores, but may develop issues such as learning difficulties, behaviour problems or infertility.
What is the success of fertilisation with ICSI?
We know that ICSI is widely employed in IVF programs globally, with 70-80% of mature eggs fertilised as a result.
There is, however, still a risk (around 2%) of damage to the eggs during the injection process itself, with further potential complications during the fertilisation itself. And, even with ICSI, there is still a very small chance that none of the eggs will fertilise.
However, more than 90% of couples who undergo ICSI will have at least one embryo to replace, with pregnancy rates similar to those of standard IVF , allowing for maternal age.
At City Infertility, we understand that your journey from diagnosis to treatment can be quite stressful from an emotional, physical and financial point of view. We always encourage partners to be supportive and involved in the treatment process, and for couples to develop networks and seek support externally, from friends and relatives.
All of our IVF treatments include a counselling session with our trained infertility counsellor. Our counsellors are highly experienced in infertility-related issues, and can help you work through some of the emotions and issues you may be experiencing.
Please contact us to receive the most current treatment cost structure.
All services are provided in a discreet environment. Your confidentiality is assured.