Intracytoplasmic Sperm Injection {ICSI}

ICSI is an abbreviation for “intracytoplasmic sperm injection”. This is one of the stages of IVF, an alternative to classic in vitro fertilization. Let’s consider in detail what ICSI is, what are the features of the procedure, its indications, its effectiveness, pros and cons.

What is ICSI?

Any IVF procedure involves fertilization in vitro, that is, outside the body, in the conditions of a medical laboratory. In the traditional method, mature eggs and sperm are mixed in one container and placed in favorable conditions with the correct temperature, humidity and light level. If everything goes well, fertilization occurs within a day.

In some cases, this method is not effective – fertilization does not occur for various reasons. To increase the chances of fertilization, the ICSI method is used.

ICSI is the introduction of healthy sperm directly into the egg. About 60% of IVF in the US is performed in this way. ICSI sequence:

1. Selection of a mature egg.
2. Preparation of sperm and selection of mature healthy sperm. The quality of the sperm is assessed visually: it must be of the correct shape, active and move in a certain way. The tail of the chosen sperm is broken to immobilize it. In some cases, even slow-moving spermatozoa are successfully used.
3. Introduction of the sperm into the egg cell. It is captured with a needle and, having pierced the ovum with it, is injected inside.
4. Embryo formation. If the fertilization is successful, the cell will begin to divide and in 3-6 days will be ready to be transferred to the woman’s uterus.

During ICSI, fertilization occurs in 50–90% of cases, depending on the laboratory.

In what cases is ICSI indicated?

Indications for ICSI:

• Low mobility of spermatozoa (which means that the chances that they will penetrate the egg by themselves are low).
• Low number of sperm in the semen (or low number of motile sperm due to diseases or natural decline in fertility).
• Azoospermia (absence of spermatozoa in semen). With such a diagnosis, sperm can be obtained directly from the testicle using techniques such as percutaneous epididymal sperm aspiration, microsurgical epididymal sperm aspiration, testicular sperm aspiration, and open testicular sperm extraction.
• Violation of ejaculation (for example, sperm cannot escape due to blockage of the reproductive tract).
• Non-occurrence of fertilization by the traditional in vitro method regardless of sperm quality. The problem may be that the shell of the egg cell is too strong or thick, and the sperm cannot penetrate it.

Many clinics of reproductive medicine by default use the ICSI method when performing IVF, regardless of the causes and factors of infertility. This allows you to speed up the onset of fertilization and reduce the number of unsuccessful attempts.

Stages of artificial insemination using ICSI

In order to perform IVF using the ICSI method, you need to obtain at least one healthy egg and sperm. The sequence of artificial insemination using ICSI:

1. Stimulation of ovulation of the potential mother. Normally, a woman’s body produces one mature egg per cycle. For IVF, you need to have at least a few to choose from. Therefore, for 8–14 days, a woman takes drugs that contribute to the maturation of more eggs. The doctor monitors their development with the help of transvaginal ultrasound and blood tests.
2. Egg collection (follicular aspiration). Through the vagina, the doctor inserts a thin needle into the ovary. With the help of ultrasound, he looks for mature follicles containing eggs. A suction device, to which a needle is connected, extracts the fluid containing the eggs from each follicle in turn. During the procedure, the woman is under anesthesia.
3. Obtaining spermatozoa. They are usually removed from semen. If this is not possible, then the spermatozoa are taken directly from the testicles or their appendages. They are removed with a needle or by biopsy (a piece of tissue is taken) under anesthesia.
4. Fertilization by the ICSI method.
5. Embryo cultivation. It usually lasts 3-5 days.
6. Carrying out PGD (examination of embryos for the presence of chromosomal abnormalities). This is not a mandatory procedure in the IVF protocol. However, it is often used to make sure that healthy embryos are chosen for transfer, which have a better chance of attaching and developing into a healthy fetus.
7. Embryo transfer into the woman’s uterus. The procedure is not painful and is performed without anesthesia. The doctor inserts a thin catheter containing the embryos into the uterus (through the vagina and cervix) and releases them. Usually from 1 to 3 embryos are transferred. If it is implanted in the mucous membrane of the uterus, then pregnancy occurs. It is confirmed after 10-12 days.

Unused embryos can be frozen in case pregnancy does not occur, or if the woman wants to undergo the procedure again.

Pros and cons of the ICSI method

The use of ICSI and IVF has advantages and disadvantages. Let’s consider them.

Disadvantages of ICSI

• Cost. The ICSI procedure is expensive, and insurances usually do not fully cover its cost. The price starts from about 6,000 euros in Europe to 17,000 dollars in the United States.
• Probability of birth defects. During natural pregnancy, the probability of birth defects ranges from 1.5% to 3%. When using ICSI, it is slightly higher. Researchers suggest that the reason is not the IVF procedure. Probably, the deviation is a consequence of the actual infertility that the couple suffers from. Less than 1% of children may have Beckwith-Wiedemann syndrome, Angelmann syndrome, or sex chromosome abnormalities.

Carrying out PGD allows you to identify embryos with abnormalities and select exclusively healthy ones for transfer.

Advantages of ICSI

• The possibility of fertilization even with severe forms of male infertility (for example, when spermatozoa have to be extracted from the testicle or its appendix)
• High chances of fertilization. In high-quality laboratories, fertilization occurs in 70-90% of cases.
• High pregnancy rate. On average, pregnancy occurs in more than 55% of cases.
• High chances of having a baby, even if an immobile spermatozoon obtained during a testicular biopsy was used.

ICSI is an opportunity to conceive a child even in difficult cases of infertility. The success of the procedure largely depends on the professionalism of the personnel who conduct it and the quality of the medical equipment. On the Family Pathway website, you can familiarize yourself with reproductive technology and infertility clinics, their offers and customer reviews.