Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) was introduced in 1992 to improve fertilization in couples with male factor infertility undergoing in vitro fertilization (IVF) or in couples with fertilization failure in a prior IVF cycle without detectable abnormalities of semen parameters
In ICSI all the steps are similar to the procedure of IVF, except the step of fertilization.
Normally in traditional IVF one egg is mixed with millions of sperms and one of the sperms fertilizes the egg on its own.
In contrast, in ICSI each egg is held and injected with a single live sperm. We use micro manipulator to inject eggs with the sperm.
It is used in all cases of male infertility and now a days even when we have less eggs we like to us ICSI to get best fertilization and embryos
Indication for icsi :
identifiable male factor
unexplained infertility
poor-quality oocytes
low oocyte yield
advanced maternal age
prior fertilization failure with conventional insemination
preimplantation genetic testing (PGT), fertilization after in vitro maturation (IVM),
fertilization of cryopreserved oocytes.
How Does the ICSI Procedure Work ?
ICSI works almost exactly like the IVF procedure, except the fertilization process
In IVF the fertilization process happens in a dish where eggs and sperms are left for self fertilization but in ICSI the sperm is injected in the egg individually using a machine called micromanipulator.
Steps involved
The controlled ovarian stimulation starts from day 2 or 3 or 4 of menstrual cycle
Sonography starts from day 2 or 3 of menstrual cycle
Gonadotropin injections are given everyday for 10 to 12 days
Monitoring of the follicular growth is done during these injections via sonography
Patient is admitted for few hrs
Egg retrieval is done under general anaesthesia
Discharge happens same day
Icsi is performed in lab
It takes 3 to 5 days for embryos to form
Embryo transfer happens either fresh or frozen is a real time decision
Husband semen analysis is done and a back up sample is frozen by ejaculatory method in patients with sperms
In cases of Azoospermia different procedures like TESA, MTESA, PESA are perfomed
For ejaculatory dysfunction : vibrators are used to get sperms or electroejaculation is used
Success rate of ICSI :
50 to 60 % depending on multiple factors like age, quality of eggs, sperms, embryos and reason for ICSI