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A Look at Intracytoplasmic Sperm Injection

Sperm sometimes fail to fertilise even when they are artificially placed within reach of eggs during a conventional in vitro fertilisation (IVF) procedure. Fertilisation failure can be an extremely stressful experience for couples undergoing IVF and embryo transfer cycles, as also for clinicians. Fertilisation failure occurs in 3% to 10% of IVF cycles, and 1% to 3% of intracytoplasmic sperm injection (ICSI) cycles. In the absence of fertilisation, an embryo is not created, and consequently, the embryo transfer stage of an IVF cycle is never reached.

Despite the advancement of assisted reproductive technologies and tools, it is hard to gauge the odds of fertilisation failure or subpar fertilisation in patients seeking fertility treatments.  The truth is, fertilisation failure isn’t limited to low-quality sperm; it has been known to occur even in cases of natural insemination with normal sperm.

Here’s where ICSI comes in. ICSI is an IVF procedure in which a single sperm is deposited directly into an egg. Defective sperm function is one of the most common causes of male infertility. Up to 15% of severe male infertility cases are attributed to genetic factors, while the remainder are triggered by environmental influences.

Over the past decade, ICSI has been used extensively to treat severe male infertility across the globe. The technique has been pointed at two types of couples: those whose prior IVF cycles have proved unsuccessful, and those who have not been able to qualify for IVF owing to low sperm motility or morphology. ICSI is usually opted for by couples with unexplained infertility, subpar or inadequate oocytes, advanced maternal age, previous fertilisation failure with conventional insemination, and a history of genetic disorders. It is also recommended for couples who would like to thaw, restore and fertilise previously frozen eggs.

The first baby created through ICSI was born in Singapore in April 1989. The technique was originally developed by Gian Piero Palermo at Vrije Universiteit Brussel. He devised the method while working at the Centre for Reproductive Medicine, headed by Paul Deveroy and Andre Van Steirteghem.

ICSI follows a phased approach, and entails the following steps:

  • Follicular stimulation of the female partner over a ten-day window
  • Transvaginal egg collection via ultrasound guidance, under anaesthesia
  • Semen sample collection from the male partner
  • If semen contains no sperm, sperm extraction from the epididymis or testes, under anaesthesia*
  • Identification of normal-looking sperm under a high magnification microscope
  • Infusion of a single sperm cell into an egg using a special micromanipulator
  • Incubation of fertilised eggs up to 5 days
  • Transfer of up to two embryos into the uterus

*The extraction of sperm from the epididymis is known as percutaneous epidydimal sperm aspiration (PESA). The extraction of sperm from the testicles is known as testicular sperm aspiration (TESA).In ICSI, sperm selection happens based on visual assessment. Physiological Intracytoplasmic Sperm Injection (PICSI) is a more precise sperm selection tool than ICSI, identifying healthy sperm using a collection of medium-based methods. A recent clinical trial showed that embryos derived through PICSI could lower the chances of miscarriage. ICSI has helped countless couples in overcoming infertility over the last 28 years.

Authored By - Dr. Indu Madhusudhan

Cloudnine Fertility - JP Nagar

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