ICSI Procedure With IVF
Injecting A Sperm Into An Egg To Create An Embryo

Intracytoplasmic Sperm Injection With IVF

Contents

• What Is ICSI?
• Who Can It Help?
• How Does It Work?
• What Is The Success Rate With ICSI?
• What Are The Side Effects Of ICSI?
• How Much Does ICSI Cost?

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Infertility Treatment For Men

ICSI stands for intracytoplasmic sperm injection. It is where a single sperm is injected into a woman's egg under a microscope using a very fine needle (thinner than a hair). The procedure is sometimes used in combination with IVF (half of all IVF procedures use ICSI). Not all couples undergoing IVF need ICSI. If the man's sperm is healthy, it can be placed in a shallow plastic dish with his partner's egg and left to incubate and fertilize naturally. ICSI is usually used where the quality of the man's sperm is impaired and the only hope of it fertilizing an egg is if it is literally injected into it.

Who Can It Help?

By having ICSI, it means that sperm do not have to swim to the egg or penetrate the outer layer of the egg. This can help couples where the man’s sperm:

• Can’t reach an egg at all.
• Can reach the egg but can’t fertilize it when it gets there.

Typically, this includes cases where the man:

• Has a very low sperm count, or no sperm count at all.
• Has a high percentage of abnormally shaped sperm. This can mean the sperm can’t swim very well.
• Is producing sperm but it is not ejaculated when he climaxes. This may be because of some blockage or a vasectomy or injury. The only way to retrieve viable sperm is extracting it with a needle (read more about extracting sperm for IVF, also known as sperm aspiration).
• Has problems getting an erection and ejaculating due to illness like diabetes or injury.

Or ICSI may be considered if there has been a poor rate of fertilization or failed previous IVF attempts.

How Does It Work?

The procedure is performed by a doctor called an embryologist. He removes layers from the woman's eggs and washes the sperm in a special solution. Then he sits down at a powerful microscope for an extremely delicate task. With one hand he holds an egg steady with a pipette (which causes suction), with the other he injects the sperm into the middle of the egg. Which sperm the embryologist chooses is another task in itself. He will choose the most 'active' looking one that is moving about. Sperm retrieved by sperm aspiration are notorious for not moving. He may add a chemical to the sperm to make them at least twitch, so he can pick out the liveliest looking one. Once the best looking sperm is chosen, it is sucked up with a needle and carefully injected into the egg. After this, the process continues as any normal IVF treatment would. The inseminated egg is incubated overnight with the hope that fertilization will occur. If the eggs do not fertilize they need to be discarded. ICSI cannot be repeated.

What Is The Success Rate With ICSI?

The average live birth rate resulting from ICSI and IVF is:
Women aged under 35: 35 percent
Women aged between 35–37: 28 percent
Women aged 38–39: 20 percent
Women aged 40–42: 14 percent
Women aged 43–44: 6 percent
Women aged over 44: 5 percent

What Are The Side Effects Of ICSI?

There are no side effects to the mother as fertilization happens in vitro (meaning out of the body). As ICSI is a relatively new procedure (since 1992), the long-term effects on a child conceived by this method are not yet known. It may be that injecting sperm into an egg could damage the egg. The risks associated so far include:-

Embryo has abnormal numbers of chromosomes (aneuploidy) leading to birth defects. The higher risk of birth defects may however be due to the underlying cause of infertility in the man rather than ICSI itself. Men with severe male infertility often have more chromosome abnormalities than fertile men. The quality of their sperm is a reflection of this.

A low sperm count caused by genetic problems may result in genetic disorders like cystic fibrosis being passed on to offspring. For this reason, PDG testing (genetic testing of the embryos before implantation) is recommended.

Inherited infertility. There is a possibility that a boy conceived by ICSI may inherit his father's infertility - as most children born by ICSI are still in their teens, it is too soon to know yet.

How To Reduce The Risks

If you are considering ICSI it makes sense to talk to a genetic counselor about screening for possible genetic disorders before starting fertility treatment. If a genetic abnormality is identified your counselor will be able to advise you of the risks of passing this on to any children you have. He may for example recommend PDG testing - genetically testing embryos for disorders before implantation in the mother. Following a successful birth from ICSI, the parents should be offered newborn screening (see baby care after delivery).

How Much Does ICSI Cost?

The average cost of ICSI is $1,900. If the sperm needs to be surgically removed from the man, this costs a further $2,500. These fees are in addition to your regular IVF costs.

For more articles, see the following:

• Genetic testing during pregnancy: When it is recommended.
• Egg donation: When IVF fails due to egg quality.
• Embryo donation: Donated embyros anyone?
• Donor cytoplasm: New IVF treatment, requires ICSI.
• Egg freezing: How ICSI is used with frozen eggs.

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