Intra-cytoplasmic sperm injection (ICSI)

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Intra-cytoplasmic sperm injection (ICSI) involves injecting a single sperm directly into an egg in order to fertilise it. The fertilised egg (embryo) is then transferred to the woman’s womb.  The major development of ICSI means that as long as some sperm can be obtained (even in very low numbers), fertilisation is possible.

Female fertility diminishes with age, so if you are using your own eggs, on average, the younger you are, the higher your chances of success. Intra-cytoplasmic sperm injection (ICSI) success rates are very similar to in vitro fertilisation (IVF) rates and as such are no longer presented separately.

* What are the medical procedures for ICSI?

As with standard IVF treatment, you will be given fertility drugs to stimulate your ovaries to develop several mature eggs for fertilisation. When your eggs are ready for collection, you and your spouse will undergo separate procedures. Your spouse may produce a sperm sample himself by ejaculating into a cup on the same day as your eggs are collected. If there is no sperm in his semen, doctors can extract sperm from him under local anaesthetic. Your doctor will use a fine needle to take the sperm from your spouse's:

  •  Epididymis, in a procedure known as percutaneous epididymis sperm aspiration (PESA), or
  •  testicle, in a procedure known as testicular sperm aspirations (TESA)

If these techniques don't remove enough sperm, your doctor will try another tactic. He'll take a biopsy of testicular tissue, which sometimes has sperm attached. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is carried out with a microscope.
TESE is sometimes carried out before the treatment cycle begins, and under local anaesthetic. The retrieved sperm are frozen. Any discomfort felt by your spouse partner should be mild and can be treated with painkillers.

After giving you a local anaesthetic, the doctor will remove your eggs using a fine, hollow needle. An ultrasound helps the doctor to locate the eggs. The embryologist then isolates individual sperm in the lab and injects them into your individual eggs. Two days later the fertilised eggs become balls of cells called embryos.
The procedure then follows the same steps as in IVF. The doctor transplants one or two embryos into your uterus and through your cervix using a thin catheter.
If you are under 40 you can have one or two embryos transferred. If you are 40 or over you can have a maximum of three embryos transferred if using your own eggs or two if you're using donor eggs. Extra embryos, if there are any, may be frozen in case this cycle isn't successful.
Embryos may be transferred two to three days after fertilisation, or five days after fertilisation. Five days after fertilisation the embryo will be at the blastocyst stage. If you're just having one embryo transferred (called elective single embryo transfer, or eSET), having a blastocyst transfer can improve your chances of a successful, healthy, single baby.
If all goes well, an embryo will attach to your uterus wall and continue to grow to become your baby. After about two weeks, you will be able to take a pregnancy test.

* What are the factors to consider?

ICSI is often recommended if:

  •  the male partner has a very low sperm count
  • other problems with the sperm have been identified, such as poor morphology (abnormally shaped) and/or poor motility (poor swimmers)
  • at previous attempts at in vitro fertilisation (IVF) there was either failure of fertilisation or an unexpectedly low fertilisation rate
  • the male partner has had a vasectomy and sperm have been collected from the testicles or epididymis (sperm reservoir)
  • other situations where the sperm count is zero and donor insemination is not wanted
  • the male partner does not ejaculate any sperm but sperm have been collected from the testicles
  • the male partner has had problems obtaining an erection and ejaculating. This includes men with spinal cord injuries, diabetes and other disorders.

* What are the success rates of ICSI?

The success rates for ICSI are higher than if you use conventional IVF methods. A lot depends on your particular fertility problem and your age. The younger you are, the healthier your eggs usually are, and the higher your chances of success.

•    The percentage of cycles using ICSI which result in a live birth are:
•    35 per cent if you are under 35
•    29 per cent if you are between 35 and 37
•    21 per cent if you are between 38 and 39
•    14 per cent if you are aged between 40 and 42
•    six per cent if you are between 43 and 44
•    five per cent if you are over 44

* What are the advantages of ICSI?

ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you. If your spouse is too anxious to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI.
ICSI can also be used to help couples with unexplained infertility, though experts haven't found that ICSI makes pregnancy any more likely than standard IVF. ICSI doesn't appear to affect how children conceived via the procedure develop mentally or physically.

* What are the disadvantages of ICSI?

ICSI is a more expensive procedure than IVF. ICSI has been in use for a shorter time than IVF. So experts are still learning about its possible effects. The same risks associated with standard IVF procedure, such as multiple births and ectopic pregnancy, apply to ICSI.
You may have a higher risk of congenital conditions such as cerebral palsy in your baby. The risk rises from three per cent for naturally conceived children to about six per cent after IVF or ICSI. One large study found a higher rate of abnormalities in ICSI babies when compared with IVF babies. But this risk is still low.
During natural conception, only the hardiest sperm manage to travel great distances and break through the membrane of an egg to fertilise it. Weaker sperm don't make it. But because ICSI bypasses this natural selection process, there's an increased risk of rare genetic problems carried by the sperm being passed on to the child. Some but not all genetic problems can be tested for before you have the treatment.
Rest assured that ultrasound scans during early pregnancy will monitor your baby's development. And if you have any worries, you will be able to talk to your doctor.

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