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Intra Cytoplastmic Sperm Injection (ICSI)

What is Intracytoplasmic Sperm Injection (ICSI)?

Intracytoplasmic sperm injection (ICSI) is a procedure in which a single sperm is injected directly into a mature egg. The embryo is then transferred to the woman’s uterus or fallopian tube. ICSI was first developed in 1992 and used in 1994. The first successful birth achieved with ICSI assistance was in February 1995.

ICSI is used together with IVF to overcome severe male infertility. In order for sperm to fertilize an egg, the head of the sperm must attach to the outside of the egg and push its way through the outer layer to the inside. For couples with serious problems related to sperm production or motility, ICSI has been a successful method. It has also proven to be a helpful method for older couples who have experienced previous failed IVF attempts.

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. Because the technique relies on a healthy egg, most of the recommendations for this procedure pertain to patients with male infertility problems. These include:

  • Men who have undergone vasectomy reversal, where there may be high levels of sperm antibodies preventing conception.
  • Men with low sperm counts or with low sperm motility.
  • Men with abnormally shaped sperm
  • Couples who have undergone previous in vitro fertilization cycles without successful fertilization or implantation.
  • In some cases, women with certain egg production conditions to verify that the egg is healthy from the start
  • If a man has a blockage in his reproductive tract that prevents sperm from making its way out.

What does the ICSI procedure involve?

As with IVF, the woman’s ovaries are stimulated with fertility medications so that several mature eggs develop. Ultrasounds are used to monitor development of the eggs, and once it is determined that the eggs are ready for harvest, they are aspirated during a transvaginal ultrasound-guided egg aspiration procedure. Heavy sedation is used during the 10- to 15-minute procedure to prevent any associated discomfort.

Sperm is then retrieved or extracted from the male donor. If male infertility is an issue, procedures for sperm extraction are utilized. The semen sample is prepared, separating live sperm from debris and most of the dead sperm. In the washing procedure, only healthy and normal sperm are left for use. Once the required number of eggs are harvested and the sperm is available, the doctor or embryologist will collect a single sperm in a tiny, hollow needle and insert it carefully into the outer membrane of the egg. Once the needle is successfully inserted, the sperm is gently expelled into the cytoplasm, or interior, of the egg. The needle is gently removed and within about three days following the procedure, the eggs are checked for fertilization. Once fertilized, the resulting embryo is implanted in the uterus in a simple and painless procedure. If more than one egg is successfully fertilized, additional embryos may be frozen for future cycles.

What are the risks with ICSI?

With ICSI, there may be damage to the egg from the needle used in the sperm injection. Also, the egg might not grow into an embryo, even after being injected with the sperm or stop growing altogether. If fertilization does occur, the likelihood of a couple seeing the pregnancy to full term and to giving birth to a baby, or to multiple babies, is no different with ICSI than with IVF.

In addition, birth defects resulting from the use of the ICSI procedure are rare. Less than one percent of children conceived with this method have a birth defect.  Some of the defects that have been associated with ICSI include:

  • Beckwith-Wiedmann syndrome – a congenital overgrowth disorder characterized by large body size.
  • Angelman syndrome – a neuro-genetic disorder characterized by intellectual and developmental delay.
  • Hypospadias - a condition in which the opening of the urethra (tube through which urine drains from the bladder) is on the underside of the penis, instead of at the tip.
  • Sex chromosome abnormalities – Downs syndrome is one example of a chromosome abnormality.

It is possible, that there are genetic causes for a couple’s infertility. Boys conceived with the ICSI procedure may face infertility issues as adults.

What is the success rate for ICSI procedures?

The success rate for fertilization with ICSI is between 50% to 80%. In certain cases where traditional IVF may not offer enough certainty or reliability, as in cases where the male donor has a very low sperm count, the intracytoplasmic sperm injection technique has resulted in a higher level of fertilization success. Success rates may also vary based on the experience and skill of the individual performing the intracytoplasmic sperm injection procedure or the implantation procedure.

What is the cost for the procedure?

ICSI is not covered by most insurance. ICSI adds an additional $1,200 to $1,800 to the total cost of IVF. Those costs do not include any potential treatments required to retrieve sperms from the male donor.

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