Infertility can affect both males and females. When a couple is unable to conceive due to fertility issues with the male, there are specific treatments to help overcome these fertility issues. ICSI is one such treatment that aims to help couples conceive despite fertility issues with the male partner. If you are considering this particular treatment, here is everything you need to know.
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ICSI stands for Intra Cytoplasmic Sperm Injection. It is a type of fertility treatment to help with male infertility. ICSI is a type of IVF that helps create an embryo by injecting the sperm directly into the egg’s cytoplasm. The egg’s cytoplasm is a gel-like substance, and the sperm has to enter this place for fertilisation. ICSI is slightly different from IVF.
In IVF, thousands of extracted sperm are placed next to mature eggs to enable the sperm to enter the egg on their own and fertilise it. In ICSI, the technician or the fertility specialist will inject one sperm directly into the egg, leaving nothing to chance. This increases the chances of fertilisation but does not guarantee it.
In both ICSI and IVF, after the sperm fertilises the egg, a zygote forms. Once this zygote starts developing into the embryo, it will be transferred into the uterus on day 3 or 5. After the transfer, it is up to the embryo and the uterus. If the embryo implants successfully in the uterus, it will lead to pregnancy. If the implantation does not succeed, it will not lead to a pregnancy.
While IVF is for couples who are unable to get pregnant for a variety of reasons, ICSI is for couples who are unable to conceive due to male infertility issues like:
● Inability to ejaculate
● Insufficient ejaculation
● Ejaculated semen flows back into the bladder instead of coming out of the body.
● Blockage in the male reproductive system
● Poor sperm health
● Poor sperm morphology (shape or motility)
ICSI can also help when male infertility is not the main issue. Fertility specialists will opt to inject the sperm directly into the egg if:
● The female partner or the egg donor is over 35 years of age.
● You are using frozen eggs and sperm. In this case, both eggs and sperm are thawed. They will inject the thawed sperm into the thawed egg directly. After thawing, the sperm, or the egg, or both may not survive until fertilisation occurs naturally. ICSI can be helpful to save time and reduce risk.
● Previous IVF attempts were a failure at the embryo formation stage. If embryo formation did not happen when both egg and sperm were left together in a dish, injecting the sperm into the egg might yield results.
Male fertility treatments involve extracting the sperm from the semen ejaculated into a sterile cup or directly from the testicles. ICSI procedure involves the following steps:
1. Collection – The first step is collecting both the eggs and the sperm for fertility treatment.
● Egg retrieval from the female partner after ovarian stimulation using hormonal injections.
● If using a frozen sperm, no sperm collection is needed. If using fresh sperm, sperm collection happens on the same day.
● The male patient has to ejaculate into a sterile container provided by the clinic. He can do this at home or at the clinic. If he chooses to do this collection at home, the semen must reach the lab within 60 minutes from the time of ejaculation.
● Semen analysis is done immediately to check the sperm count, motility, and quality.
● If sperm is not enough due to azoospermia, hypospermia, or retrograde ejaculation, the healthcare provider will collect the sperm directly from the testicles using electro-ejaculation or TESE. This kind of extraction can be done even for men with vasectomies.
2. Injection – Once the sperm and eggs are ready, it is time for ICSI.
● The fertility specialist will hold the egg in a lab dish with the help of a small glass tube attached to a suction device.
● One sperm is picked from the collected sperm using a thin needle.
● The needle is slowly inserted into the cytoplasm of the egg with care.
● The sperm is injected into the cytoplasm.
● The needle is slowly withdrawn from the egg.
3. Monitoring – After ICSI, it is time to monitor the egg to check if fertilisation is successful and results in the formation of a zygote.
● The fertility specialist will keep the egg in a lab dish under close monitoring.
● Blastocyst evaluation happens on the 5th or 6th day to check the size and mass of the egg to determine when it can lead to pregnancy.
● Embryo transfer happens as per discussion with your doctor. The transfer usually happens on day 3 or day 5, but it can vary from case to case, depending on multiple factors.
4. Embryo Transfer – Once the embryo is ready, it’s time to transfer it.
● With the help of a long catheter and guided by an ultrasound probe, the doctor will transfer the embryo into the uterus.
● The embryo is left in the uterus for implantation.
● The next two weeks are crucial. The woman has to be careful during this time.
● A pregnancy test is taken after two weeks to confirm pregnancy.
ICSI offers the following benefits:
● For men who are suffering from ejaculation issues, ICSI helps the sperm reach the egg without any ejaculation
● ICSI increases the chances of fertilisation as the sperm is injected directly into the cytoplasm.
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ICSI also has its own set of risks, such as:
● Damage to the egg or eggs during needle penetration.
● The sperm may not fertilise the egg successfully.
● The embryo may not implant or develop further after the embryo transfer.
This procedure also carries some risks to the baby –
● Higher chances of congenital conditions in the baby
● Higher risk of autism, growth disorders and intellectual disabilities
ICSI has about a 50% to 80% success rate and is used in more than 50% of IVF treatments. Despite the high fertilisation rates and various other benefits ICSI has to offer, the results are not guaranteed. ICSI may or may not work for you. You and your partner may need to try multiple rounds to get pregnant successfully. The outcomes of the treatment can also vary according to age, egg and sperm quality, and the overall health of both partners.
Male infertility can be due to various issues, and it can affect pregnancy attempts, just like female infertility. ICSI is a type of IVF that aims to increase the chances of egg fertilisation. If you and your partner are experiencing infertility or difficulty in conceiving, consult a fertility specialist to decide whether ICSI can be a suitable option for you.
In the ICSI procedure, one sperm from the extracted semen is injected directly into the cytoplasm of the extracted egg using a thin needle. The egg is then left in a lab dish to develop into an embryo. Once the embryo crosses the blastocyst stage, it is transferred into the uterus for implantation to take place.
Both ICSI and IVF are fertility treatments, but ICSI is mainly used in the case of male infertility issues like low sperm count, poor sperm quality, or if using a frozen sperm. In IVF, the fertilisation process is left to chance by just placing the egg and sperm together. In ICSI, the sperm is directly injected into the egg to increase the chances of fertilisation.
An ICSI cycle can take about 4 to 6 weeks since the egg also needs extraction. The injecting procedure, after collecting the semen and isolating the sperm, will not take more than 30 minutes.
Yes, ICSI can be done using a frozen sperm. The technique and reliability of using frozen sperm are as good as using freshly collected sperm. The results are also very similar.
