Intracytoplasmic Sperm Injection (ICSI)
ICSI is a type of assisted microsurgical fertilization that involves the injection of a single sperm directly into an egg. Eggs for ICSI are obtained in exactly the same way as those for IVF. Following the egg retrieval, the cells surrounding each egg are carefully removed. The eggs are then examined under a microscope and those that are judged as mature are suitable for injection. The sperm are washed and prepared. The egg and sperm are then placed on a special microscope that has micromanipulator attached to it. One micromanipulator holds the egg in place, while the other is used to inject the sperm into the egg. The remainder of the procedure is similar to standard IVF with regard to the incubation of the eggs and transfer of the resulting embryos.
ICSI may be recommended in following conditions
• Oligospermia – very low sperm counts
• Asthenozoospermia – poor sperm motility
• Teratozoospermia – too many abnormal sperms
• Problems with sperm binding and penetration.
• Antisperm antibodies of sufficient quality to prevent fertilization.
• Prior fertilization failure with standard IVF cycles and fertilization methods.
• Absence of sperm in the seminal fluid (Azoospermia) – In this situation, sperm are obtained from the epididymis by a procedure called microsurgical epididymal sperm aspiration (MESA) or from the testes by testicular sperm extraction (TESE).
Thus very few azoospermic men need to resort to a sperm bank now with the availability of ICSI.
Perinatal outcome studies in Europe suggest that although multiple pregnancies are common with ICSI, there is no evidence of increased incidence of congenital malformations or abnormal karyotype. There is no evidence that abnormalities may arise later in life to babies born as a result of ICSI, although there is also no guarantee that all babies will be normal.