Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection, or ICSI, is a procedure which involves injecting sperm directly into an egg to improve the chances of fertilization. The egg is then grown in a laboratory for a few days before it is implanted directly into the woman's uterus. With ICSI, only a single healthy sperm is needed for each egg. This procedure is often performed in cases where the sperm cannot penetrate the outer layer, or cytoplasm, of the egg. ICSI may be used to increase the chances of fertilization with an in vitro fertilization, or IVF procedure.
Candidates for ICSI
Many couples consider intracytoplasmic sperm injection after past attempts at becoming pregnant have been unsuccessful. The ICSI procedure is often performed to treat a variety of infertility issues that may include:
- Male partner with low sperm count
- Blockages in the male reproductive tract
- Sperm which are shaped incorrectly or cannot penetrate the egg
- Unreceptive or abnormal eggs
In some cases, couples may consider the ICSI procedure after traditional IVF treatment has been unsuccessful.
The ICSI Process
Intracytoplasmic sperm injection is often performed in conjunction with the IVF procedure. Prior to the ICSI procedure, ovulation induction treatments may be performed to produce multiple eggs. During the ICSI, the eggs are collected through a needle guided by ultrasound through the abdomen to the ovaries. Sperm are then collected for fertilization. The semen is centrifuged to separate active sperm from inactive seminal fluid and sperm. It is then tested for motility, shape, concentration, and volume.
After the active sperm is collected and separated, it is washed to remove any toxic chemicals. One sperm is precisely injected into each egg and incubated in the lab for one to five days. The fertilized eggs are then evaluated for viability. Two to four successfully fertilized eggs are then placed into the uterus or fallopian tube using a catheter. One of the fertilized eggs should attach itself to the uterus for pregnancy. The remaining fertilized embryos may be frozen or cryopreserved for future IVF attempts.
The ICSI is performed as an outpatient procedure, but following the embryo transfer, the patient must rest in bed for several hours, before they are discharged. Two weeks after the embryo transfer, the physician will perform a pregnancy test. Women may require regular blood tests, hormone injections and continued monitoring after ICSI insemination.
Risks of ICSI
Risk factors for ICSI are similar to those of IVF procedures, which includes the rare occurrences of birth defects, multiple births, and ovarian hyperstimulation syndrome. Risks associated specifically with the ICSI procedure may include:
- Damage to the eggs
- Eggs that may not grow into an embryo after injection with sperm
- Growth problems with the embryo
Other factors that may decrease the success rate of ICSI may include:
- Older age of male and female
- Poor egg quality
- Poor sperm quality
- Duration of infertility
- Female reproductive issues, such as endometriosis
When ICSI is used in combination with in vitro fertilization and eggs of good quality, it is often a successful treatment for men who have impaired sperm or low sperm count. Freshly fertilized eggs also have a greater chance of success with ICSI than cryopreserved eggs or embryos.
Ethical and legal concerns of IVF may also accompany ICSI. Many couples may experience physical and psychological stress during infertility treatments, which can be costly, and may not be covered by insurance. The couple should discuss all fertility treatment options with a physician to determine the best approach to treat issues of infertility.