Intra Cytoplasmic Sperm Injection (ICSI)

Intra Cytoplasmic Sperm Injection (ICSI) is a micro manipulation technique in which fertilization is brought about by the injection of a single spermatozoon into an unfertilized egg. ICSI is performed with eggs obtained after ovulation stimulation as for IVF, and has greatly improved the treatment of male infertility as a result of severe oligozoospermia.

Fertilization occurs in 50% to 80% of injected eggs. Approximately 40% of all ICSI cycles performed in resulted in a live birth, which is comparable to rates seen with traditional IVE Younger patients may achieve even more favorable results. Factors such as poor egg quality and advanced maternal age may result in lower rates of success.

Though, the treatment is for male subfertility, most of the treatment is given to the wife. The basis for the treatment is to produce as many eggs as possible instead of just one as happens naturally every month.

To achieve this, the natural hormones need to be suppressed first. Then high doses of hormones are given to stimulate the growth of eggs.

The course of one treatment is approximately 5 – 6 weeks. The treatment starts 21 days after the last menstrual period, with daily injections of a hormone (lupride). In some cases a single (depot) injection can be used instead, with effect lasting for a month. This is to suppress the natural hormones concerned with ovulation. A menstrual period occurs usually within 7 – 10 days of injections.

The injections to stimulate the ovaries are then given daily for approximately 10-12 days. The response is monitored by doing ultrasound scans and blood tests regularly. The eggs cannot be directly seen on the scan. But the follicles in which they grow are seen easily. Once they reach the appropriate size, another injection (HCG) is given to mature the eggs. The eggs are then collected 36 hours later using a transvaginal ultrasound and a fine needle. This procedure is not very painful and requires only some sedation. After the eggs are collected, they are cleaned and kept in a special fluid (Culture media) in the incubator.

Around the same time as egg collection, a semen sample is taken from the husband. If ICSI is done because the sperm count or activity is reduced, then the husband is asked to produce the sample in the usual way. If the treatment is because of the blockage in the transport system, then the sperm are directly aspirated from the epididymes or a fine biopsy of the testis is done to collect the sperm. When such procedures are done, any extra sperm remaining after the treatment can be stored for future use.

Once the sample of sperm is prepared, each egg is injected with a sperm, using extremely delicate and sophisticated instruments, under a powerful microscope. After an overnight incubation, they are checked to ensure fertilisation. Then they are incubated for a further day or two and checked at regular intervals to assess their development.

Two to three days after the collection of eggs (at times five days), the embryos are put back inside the uterus (embryo transfer). Following this we have to wait for about 15 days to know the result of the treatment.