Intra Cytoplasmic Sperm Injection

What is ICSI?

ICSI is the short form for Intra Cytoplasmic Sperm Injection. It means injection of a sperm into an egg (ovum).

When is it necessary?

This treatment is for those subfertile couple in whom there is problem in the quantity or quality of sperm. There may be grossly reduced number and motility of sperm in the semen. There may be very few normal looking sperms. In other cases the sperm, though normal in number, may not be actively motile. In yet another group though the sperm are produced they may not be coming out of the testis due to a block in the tube which carries the sperm to the outside. In such cases ICSI is the ideal treatment. It is also selectively offered in women over 37 years of age, those with poor response and unexplained subfertility.

How is it done?

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.

Are there any simple alternatives to ICSI?

For those men with reduced number or motility, various medications have been used, usually without any significant improvement. In selected cases, surgery for varicocele may be considered. For those with blockage, an operation to unblock the passage can be attempted. However, the success rate with any of these methods is poor.

What is the success rate of ICSI?

The success rate varies depending on the reason it is being done and the age of the woman going through the treatment. It is generally about 45% per cycle.

This leaflet should help you to understand what is involved in ICSI. However, it does not cover all the aspects. If you wish to obtain more information or discuss anything in detail, please do not hesitate. You can directly come to the clinic or take an appointment by phoning us on 0231 2520269 / 2688991. This should avoid any undue waiting before consultation.