ICSI is an acronym for intracytoplasmic sperm injection - which is primarily a long, fancy way of saying "inject sperm into the middle of the egg". ICSI is a very effective method to get fertilization of eggs in the IVF lab after they have been retrieved from the female partner. This will usually result in normal fertilization in approximately 70-85% of eggs injected with viable sperm. First, the woman must be stimulated with medicines and have an egg retrieval procedure so that several eggs can be obtained in order to attempt in vitro fertilization and ICSI.
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Who should be treated with intracytoplasmic sperm injection?
Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these two extremes. Many clinics are currently recommending in vitro fertilization with ICSI for:
- All couples with severe males factor infertility that do not want donor sperm insemination.
- All couples with infertility with:
- Sperm concentrations of less than 15-20 million per milliliter
- Sperm motility less than 35%
- Very poor sperm morphology (subjective - specific cutoff value is not appropriate)
- All couples having IVF who have had a previous cycle with no fertilization - or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
- All couples having IVF who have a very low yield of eggs at the egg retrieval
How is ICSI performed?
- The mature egg is held with a specialized holding pipette.
- A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.
- This needle is then carefully inserted through the zona (shell of egg) and in to the cytoplasm of the egg.
- The sperm is injected in to the cytoplasm and the needle carefully removed.
- The eggs are checked the next morning for evidence of normal fertilization.
Fertilization and pregnancy success rates with ICSI
Fertilization rates for ICSI: Most IVF programs see that about 70-85% of eggs injected using ICSI become fertilized. This is called fertilization rate, which is different from the pregnancy rate.
Pregnancy success rates for in vitro fertilization procedures with ICSI have been shown in some studies to be higher than for IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quality and quantity) as compared to some of the women having IVF for reasons other than male factor infertility.
Another way to say this is - average egg quantity and quality is usually better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs - as compared to cases with unexplained infertility in which there is more probability of a somewhat reduced egg quantity and quality (on the average, since some women in this group have egg related issues).
ICSI success rates vary according to the specifics of the individual case
- ICSI technique used,
- Skill of the individual performing the procedure,
- Overall quality of the laboratory,
- Quality of the eggs,
- Embryo transfer skills of the infertility specialist physician performing the procedure.
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