ICSI (Intra-Cytoplasmic Sperm Injection) Treatment
ICSI means Intra-Cytoplasmic Sperm Injection. In this technique an ICSI machine is used which has one pipette to hold the egg and another pipette to inject the sperm directly into the oocyte's cytoplasm, rather than waiting for the sperm to do so on its own strength. This technique increases the possibility of fertilization and is especially helpful for couples who have a prior history of fertilization failure or those with poor semen parameters.
ICSI Treatment was first used successfully in 1992. In ICSI, an embryo is produced using only 1 egg and 1 sperm, so this technique can be applied under the following circumstances:-
- Cases of severe sperm disability
- When sperms are taken out from the epididymis or testis
- To improve fertilization rate even when make factor is normal
For pregnancy, a woman’s egg must be fertilised by a sperm. For fertilisation the head of the sperm must attach to the outer layer of the egg. Once this attachment occurs there is something called an “acrosomal reaction” takes place and this sperm pushes through the layers of the egg to get inside the egg cytoplasm.
Sometimes the sperm is not able to penetrate the outer layer of egg for a variety of reasons. Various reasons for the sperm not able to penetrate is:
The egg’s outer layer may be thick or hard or the sperms may be at fault. In these cases, a procedure called intracytoplasmic sperm injection can be done along with IVF to help the egg fertilise.
How does ICSI differ from traditional IVF?
There are two ways that an egg may be fertilised in IVF
Traditional IVF where in 50,000 or more sperms are placed around the egg in a laboratory dish. Fertilisation occurs when one of these sperms enters the cytoplasm of the egg. It is a more natural way of fertilisation.
In the ICSI process, a tiny needle, called injecting micropipette, is used to inject a single sperm into the cytoplasm of the egg.
Who all need ICSI?
• The male partner produces very less sperms to do IUI or IVF.
• The sperm may not be motile in a normal fashion.
• The sperm may have trouble attaching itself to the outer layer of the egg.
• Any blockage in the male reproductive tract may prevent sperms from getting out.
Severe male infertility is not the only reason for ICSI. Other evidence-based reasons include:
• Previous IVF cycle had few or no fertilised eggs with traditional IVF.
• Frozen sperms are being used.
• Frozen oocytes are being used.
• Preimplantation genetic diagnosis needs to be done
preimplantation genetic diagnosis is an IVF technology that allows for the genetic screening of embryos. There is a concern that the traditional IVF technique may cause sperm, who have not fertilized the egg, to be still surrounding the embryo and this may interfere with accurate PGD results.
• IVM (In Vitro Maturation) of oocytes is being used.
Some debateable uses
ICSI can be of great help in particular situations, however, there is some disagreement on its uses and its ability in improving success rates of in vitro fertilisation.
Some debateable uses of ICSI
• Very few eggs retrieved in IVF cycle. The fear is that, with few oocytes, what if they won’t fertilise with traditional IVF. In these circumstances, ICSI is done thinking that it will help improve fertilisation rates.
• Unexplained infertility In these cases, as we don’t know what is wrong so taking all measures to get more embryos is a good action plan.
• Advanced maternal age.
• Routine ICSI for everyone Few IVF Doctor believe that every patient should go for ICSI to eliminate the possibility of fertilisation failure.
Success rate
one might feel and assume that with the help of ICSI all eggs can be fertilised, but the fact is they don’t. With the ICSI procedure fertilisation rate is 50 to 80%,as fertilisation can't be guaranteed even when a sperm is injected directly into the cytoplasm of the egg.
Fertilisation rates don’t dictate clinical pregnancy or live birth rates. The success rate for a couple using IVF – ICSI is the same as a couple using conventional IVF treatment.
Risks
ICSI comes with all the risk of the traditional IVF cycle, but the ICSI procedure does introduce few more additional risks.
A normal pregnancy has 1.5% to 3% risk of major birth defects. ICSI treatment increases risk of birth defect to a slight extent but still it’s rar like e only.
Some birth defects like Beckwith weidmann syndrome (BVS), Angleman syndrome, Hypospadias, and sex chromosome abnormalities are more likely to occur with ICSI. They are occurring in less than 1% of babies conceived with ICSI.
There is also a slight increased risk of male baby having same fertility issues as the father has because male infertility cause may be passed on genetically.