What is ICSI and how is it performed?
Abbreviation ICSI is one of the methods of in-vitro fertilization — intra-cytoplasmic sperm injection. This method is one of the alternatives of extracorporal fertilization. This method is used in many types of infertility, especially male infertility.
For the first time, fertilization by ICSI was successfully performed at the end of the 20th century in the Belgian Research Institute. Since that this method is widely used worldwide giving a hope to infertile couples to have their own children.
Indications for ICSI
Usually ICSI is performed when several other options of in-vitro fertilization failed. However the main indication for the procedure is various types of male infertility:
- Inadequacies of sperm concentration in 1ml of the sperm (lower than 10 million);
- Sperm cells activity is not high enough in 1 ml of the sperm (lower than one million);
- A high level of morphologically abnormal sperm cells (lower than 5% of the normal cells);
- The absence of the mature and ready for fertilization sperm cells in the seminal fluid (however in the testicles there are active forms as detected through the puncturing);
- Damaged ejaculate;
- Autoimmune male diseases (damage of testicular tissue);
- Improper semen cryopreservation.
ICSI is the method which will be beneficial for those who do not want to use the donor sperm.
How is ICSI performed?
All the stages of the in-vitro fertilization do not change until the moment of embryo cultivation. While doctors monitor the development of the follicles in a female body, other specialists examine a man.
At first, it is necessary to analyze the sperm and select the best sperm cells for further fertilization. Mature, active and healthy forms of the sperm cells are detected by the binding with hyaluronic acid.
However, there is a risk that there are no suitable sperm cells in a male ejaculate. In this case, puncture of the testicles is performed as there may be suitable cells fertilization. Only one sperm cell is required for the ICSI, so most probable that proper material will be collected.
The procedure is performed if there is a mature egg collected from a female follicle and a sperm cell collected in a man. ICSI is performed under a microscope. A mature egg is placed into a special liquid to prevent its damage and they remove its protective layer. The sperm cell is immobilized and then is picked up with a fine glass needle and injected directly into the egg. The needle is removed and the procedure is complete.
Further actions repeat the protocol of extracorporal fertilization. The fertilized egg is placed into the incubator and then implanted into the female uterus.
The difference between IVF and ICSI is that in the first case fertilization is performed naturally and in ICSI the injections are used which enables the doctors to monitor the process.
Preparation for ICSI
Before performing artificial fertilization a couple should undergo a very thorough examination. It is necessary to detect possible contraindications and concomitant pathologies in a woman and to identify inadequacies of the sperm in a man.
Both a man and a woman should have tests for sexually transmitted diseases and other diseases which may be transmitted to a fetus and put its life at risk. A woman should also have tests to identify the level of hormones.
After all the examinations and tests are done, the doctor develops a plan (or a program, or a protocol) for performing fertilization and decides if ICSI is required.
Chances of success with ICSI
Statistics shows that the chances for successful fertilization by injecting the sperm cells are the same as in common in-vitro fertilization. It means the chances are about 40%. However the chances are much higher if infertility is not severe but the chances are much lower if the couple already had failures with IVF.
Age also plays a great role, so women over 30 years old have a lower chance of success. Younger women get pregnant after ICSI in 50% of all cases.
Main disadvantages of the method
The main and the most dangerous disadvantage of ICSI is the use of affected sperm. The best sperm cell is selected but the disease never disappears and may cause pre-natal abnormal development or genetic pathologies. Besides, male infertility may be transmitted to the descendants.
Of course, qualification of the doctor who is going to perform injection is critical. Medical malpractice may lead to a multiple fetation or a stillbirth.
ICSI is not studied very well yet, so it does not give a one hundred percent guaranty. However, for many couples it is the only hope to have their own child.