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| IntraCytoplasmic Sperm Injection (ICSI) | IntraCytoplasmic Sperm Injection is considered to be quite a new, though well – established procedure. It was developed in order to provide help with male factor fertility. The very procedure consists of injecting a single sperm into the cytoplasm of each separate egg with the help of a fine glass needle. The Intra – Cytoplasmic Sperm Injection has become widely used instead of the two previously developed procedures: PZD (Partial Zona DIssection) and SUZI (Subzonal Insemination), because much higher fertilization rates are possible to achieve with the help of ICSI.
However, it should also be noted, that ICSI is not legally allowed in all countries, (for example, it is prohibited in the UK), because in immature sperm the nuclear maturation process may be incomplete.
For whom ICSI is advised?
There exist selected groups of patients, to whom Intra – Cytoplasmic Sperm Injection may be recommended. Here belong:
Couples who have failed to achieve fertilization, or who had very poor fertilization following standard In Vitro Fertilization treatment;
Men, who have abnormal sperm parameters, such as poor motility, low count, high percentage of abnormal forms and high levels of antisperm antibodies in their sperm;
Men, who suffer from azoospermia, which means complete absence of sperm in their ejaculate, and who have had their sperm retrieved with the help of a surgery;
When frozen sperm is limited either in number or in quality, or in both.
It should also be noted, that Intra – Cervical Sperm Injection is usually of no success, if it is used to treat fertilization failure, the reason of which is poor egg quality.
The ICSI procedure
The first stages of Intra – Cervical Sperm Injection are the same as for standard In Vitro Fertilization. The woman is to take fertility drugs in order to provide stimulation of her ovaries in such a way, that several mature follicles would grow and develop. After that these eggs are usually collected with the help of a vaginal ultrasound scan into a culture medium, which is specially prepared. As soon as the eggs are collected, they are closely examined under a microscope in order to have their quality estimated. Then the eggs are put into the incubator for a definite period of time, usually it is 3 – 6 hours. And finally, the eggs are taken away from the incubator and those cells, which surround the egg, are stripped off in order to have the maturity of the egg estimated. It is necessary to do, because Intra Cytoplasmic Sperm Injection is only possible to perform with mature eggs. In case if there are any immature eggs, they can be kept in the culture medium and injected the following day, if they show any signs of coming maturation.
Sperm is collection from ejaculate or aspirate from the epididymis (PESA) or testis (TESA or TESE) is performed with the help of a special cultured medium. It is also possible to obtain sperm either from frozen semen sample of testicular tissues.
Anyway, as soon as the eggs are selected, the sperm, which is chosen, is rendered immotile, and then it is sucked into the tip of an extremely fine needle, made of glass and injected right into the egg. The egg is kept in place with the help of gentle suction of the opposite side of it; here a holding pipette is used. The very procedure is extremely delicate, and micromanipulator is necessary to be used, while it is performing. The same process is repeated for every single egg. The egg membrane has the elastic nature, which means that the tine hole, which is made by the needle, gets closed quickly enough. According to the statistics, about 5 percent of the injected eggs may get damaged while the procedure is conducted.
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