Fertility Treatment Procedure
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection/ICSI is an infertility treatment method in which a highly trained specialist injects a single donor sperm into a single donor egg to aid in successful fertilization of the egg in a highly controlled laboratory setting. The ICSI technique is performed as an adjunct to traditional in vitro fertilization (IVF) techniques, and offers more effective and reliable options for infertile couples. Once fertilized, the embryo is implanted in the uterus where it will develop until birth.
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Who is candidate for intracytoplasmic sperm injection?
In general, anyone who decided to undergo in vitro fertilization may also choose to have the specialized intracytopalsmic sperm injection technique performed, as well. For a certain set of patients, the technique is highly recommended. Because the technique relies on a healthy egg, most of the recommendations pertain to male infertility problems. Intracytoplasmic sperm injection is therefore highly recommended for men who have undergone vasectomy reversal, where there may be resultant high levels of sperm antibodies that may prevent conception. Similarly, intracytoplasmic sperm injection is a good option for men with low sperm counts, or with low sperm motility. The technique may also be recommended for couples who have undergone previous in vitro fertilization cycles without successful fertilization or implantation. In some cases, intracytoplasmic sperm injection may be recommended for women with certain egg production conditions, to ascertain that the egg being fertilized in healthy from the start.
Is ICSI appropriate for all male fertility problems?
There are some male fertility problems for which ICSI may not be the solution. Some men have a low sperm count which, as a result of a genetic problem, could be passed on to any sons conceived via ICSI. A blood test to screen for such problems is often recommended before starting an ICSI cycle. You should be offered counselling before and after taking the test to help you prepare for and cope with the results.
How is the procedure performed?
As with standard IVF treatment, a woman will be given fertility drugs to stimulate her ovaries to develop several mature eggs for fertilisation. (Women normally release only one egg a month.) Once the eggs are ready, the man and the woman undergo separate procedures. The man may produce a sperm sample himself by masturbating into a cup, but if there is no sperm in his semen, doctors can retrieve sperm from the man. In most cases the sperm is extracted with a needle from a testicle under anaesthetic. If this doesn't remove enough sperm, the doctor will take a biopsy of testicular tissue, which sometimes has sperm attached. This procedure is called testicular sperm extraction (TESE). It's sometimes done before the treatment cycle begins, and the retrieved sperms are frozen. After giving the woman a local anaesthetic, the doctor will remove her eggs using a fine, hollow needle. (An ultrasound helps the doctor locate the eggs.) A lab technician then isolates individual sperm and injects them into individual eggs. Two days later the fertilised eggs become balls of cells called embryos. The procedure then follows the same steps as in IVF. The doctor transplants one or two embryos into the woman's uterus through her cervix using a thin catheter. A maximum of three embryos can be transferred if the woman is over 40 years old and is using her own eggs, one or two if she is using donor eggs. Extra embryos, if there are any may be frozen in case this cycle isn't successful. One embryo may attach to the uterine wall and continue to grow. After about two weeks, the woman can take a pregnancy test.
How long will the treatment last?
One cycle of ICSI takes four to six weeks to complete. You and your partner can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You'll go back two days later for the embryo implantation.
What's the success rate?
The success rate of ICSI is increasing as more and more clinics become experienced in the technique. Many clinics now find that their clinical pregnancy rates for ICSI are higher than those achieved using conventional IVF methods. The national average success rate for ICSI for women aged under 35 years is around 50 per cent.
What are the advantages?
This technique opens doors to parenthood that were previously closed to some couples with a male factor fertility problem. ICSI gives men with a very low sperm count or other fertility problems a chance of conceiving their genetic child. It is possible to use immature sperm that have been retrieved from the man's testicles so ICSI can be used, for example to help men who have had a vasectomy that cannot be reversed. ICSI can also be used to help couples with unexplained infertility, but experts have not found that it makes pregnancy more likely than standard IVF.
What are the risks?
Like any medical or laboratory procedure, ICSI does have certain risks. Despite the technology and mechanical advances that make ICSI a viable and reliable option, in some cases the needle used in the intracytoplasmic sperm injection treatment may irreparably damage the donor egg during the procedure. Needle damage has been reported in less than 5 percent of all treated eggs. The intracytopalsmic sperm injection treatment has also been shown to be related to a higher risk for chromosomal abnormalities in the babies conceived using technique. The risk is about 8 in 1,000 or 4 times the risk of natural conception. Chromosomal abnormalities may include heart problems requiring surgical intervention; learning or behavioral disorders and disabilities; and infertility in the child once he or she reaches adulthood. In addition, some chromosomal abnormalities may cause miscarriage of the embryo or fetus.
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