I.C.S.I

INTRACYTOPLASMIC SPERM INJECTION

What is ICSI and who is it used for ?

ICSI is a treatment which has been specifically designed for patients with severe male factor infertility and for whom conventional IVF is inappropriate,has failed, or has produced very poor fertilisation previously. Its main advantages over routine IVF is that we only need one sperm to inject into each egg and therefore it is possible to achieve fertilisation in cases with severe reduced sperm counts, poor sperm motility, or low numbers of normally shaped sperm. It can also be used in cases where sperm has to be removed surgically from the testis.

The treatment was first developed in Brussels and is now offered by many IVF clinics worldwide. ICSI involves injecting a single sperm directly into the centre of an egg using a fine glass needle. The treatment is an additional step to routine IVF, Where instead of the sperm being added to the media containing the eggs,they are injected individually into each egg. Before and after this step, the treatment is the same as for routine IVF.

Are all the eggs injected ?

Usually all of the mature eggs will be injected with sperm, but occasionally if the sperm is found to be of borderline quality it may be difficult to decide whether or not ICSI is needed. If this is the case it is possible to inseminate a proportion of the eggs using ICSI and the remainder with conventional insemination. ie: without microinjection. If fertilisation is achieved in this latter group of eggs you will know that ICSI may not be necessary in the future. In order to take these findings of knowing ideally a clinic would need 15-20 eggs in order to split the eggs realistically. This is because embryos can only be replaced from one group only either IVF or ICSI treatment. If the sperm are of suitable quality the embryologist will discuss all options before any eggs are injected on the day of treatment. However in known factors of poor sperm quality ICSI would certainly have been discussed as being a priority option bypassing straight IVF.

How successful is ICSI ?

Not all eggs are suitable for for injection. A small number may be immature or of poor quality. Of those eggs that are injected 60% will fertilise normally, however poor the sperm quality. The only factor which seems to affect fertilisation is sperm motility. If there are no motile sperm present we do not know if those sperm are dead or merely immotile. The percentage of eggs fertilising in these cases is around 25 -30%. The chances of achieving a pregnancy with ICSI is very similar to that with conventional IVF. Its always a good idea to ring IVF clinic and ask a member of staff for there latest success rates.

Are there any other risks ?

It is very important to remember that ICSI is still a relatively new technique. It involves passing a pipette through the inner and outer membranes of the egg to place a sperm directly into the middle of the cytoplasm. This disruption does not appear to have any adverse effects on the developmental potential of the embryo. However it has been shown that men with very low sperm counts have a higher risk of some kind of chromosomal abnormality. Many of the abnormalities found are very small rearrangements on some chromosomes which cause no visible symptoms. However they may be causing problems with sperm production and there may also be a chance of passing on the chromosome defect to a future child. Note: that the majority of abnormalities do not cause fetal malformations. The risk of a fetal malformation has been shown to be no higher than a routine IVF,

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