What is ICSI?
Intracytoplasmic
Sperm Injection (ICSI) is a form of
assisted reproductive technology (ART)
that is used to help infertile couples
conceive. Similar to in
vitro fertilization (IVF), eggs
are removed from the woman’s
ovaries and sperm is collected from
the male. But, while the eggs and
sperm in IVF are placed together in
a container where fertilization takes
place of its own accord, in ICSI,
a sperm is individually injected into
each of the mature eggs. The embryos
are then placed into the woman’s
uterus.
ICSI
is designed to aid couples that suffer
from male
infertility, particularly low
sperm count or poor sperm quality.
The success rate of ICSI is similar
to that of IVF – possibly as
high as 30 percent. The two procedures
have about the same incidence of multiple
gestation.
Who
is a candidate for ICSI?
ICSI
is intended for couples with male
infertility factors that prevent fertilization
even when sperm is exposed to an egg.
Examples include:
- Low sperm count
- Poor sperm motility
- Abnormally-shaped sperm
- Inability of sperm to bind to
or penetrate the egg
The procedure is unlikely
to help couples with poor egg quality.
How
is the ICSI procedure performed?
The Intracytoplasmic
Sperm Injection process starts a few
weeks before the operation with a
meeting between the patients and the
surgeon. The surgeon will start a
series of hormone injections for the
female to promote production of eggs.
Also, the patients will be given instructions
on how to adjust diet, exercise, and
other behaviors in the coming weeks.
ICSI is usually performed
as an outpatient procedure, as it
requires little recovery time.
Whenever possible,
sperm is collected by way of ejaculation.
However, the doctor can perform one
of several surgical methods of sperm
collection if the male patient is
unable to ejaculate due to obstruction
of the reproductive tract. The eggs
are harvested from the female via
laparoscopy or using a sonogram. In
laparoscopy, the ovaries are accessed
through incisions in the abdomen and
the eggs are suctioned out. The alternative
is to insert a needle through the
vaginal wall, guiding the egg extraction
with a sonogram image.
Next, in a laboratory
dish, a single sperm is injected directly
into the cytoplasm of a mature egg
using a pipette. For older patients,
this may be performed on as many as
five eggs. Usually, between 50 and
80 percent of the eggs on which ICSI
is performed are actually fertilized.
The fertilized eggs are allowed to
mature into embryos, then are inserted
into the woman’s uterus at the
appropriate time in her menstrual
cycle. The woman must lay down for
about an hour before returning home
to rest. ICSI, like all ART procedures,
takes a significant emotional and
physical toll on the woman.
The
complications associated with ICSI
are similar to those of IVF –
primarily ovarian hyperstimulation
syndrome and multiple pregnancy. Ovarian
hyperstimulation occurs due to the
hormones used to stimulate egg production.
The condition is marked by fluid buildup
in the abdomen, which, in the most
severe cases, can cause damage to
internal organs. Some claim that ICSI
also increases the fetus’s risk
of hypospadias, a congenital malformation
in which the urethra opens on the
underside of the penis. However, as
yet this claim is unsubstantiated.
Some also believe that genetic male
infertility can be passed on to the
child, but this is also yet to be
determined.
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