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Intracytoplasmic sperm injection (ICSI) can be used as part of an in vitro fertilization (IVF) technique to help you conceive . ICSI is the most successful form of treatment for male infertility and is used in nearly half of all infertility treatments. ICSI takes one sperm, which is injected directly into the cytoplasm of the oocyte (egg). The fertilized egg (embryo) is then transferred to your uterus (womb).
shown in the image is the ICSI (Intra cytoplasmic sperm injection) process in which one sperm is being injected in one oocyte (egg) for fertilization. ICSI is the treatment of choice for male factor infertility. Cases in which the sperm count is low or the sperm motility is less , which means that the sperm is either unable to reach the egg or to enter the egg. This can be assisted by the help of ICSI.
Numerous couples conceive with the help of ICSI. This is one of the most advanced techniques. ICSI got a revolutionized infertility treatments and got us closest to fertilization. In ICSI forced fertilization , which is inserting the sperm directly in the egg with an injection pipette.
MALE INFERTILITY INCLUDES
- Aspermia - complete lack of semen
- Asthenozoospermia - reduced sperm mobility
- Azoospermia - absence of sperm cells in semen
- Hyperspermia - large semen volume
- Hypospermia - small semen volume
- Oligozoospermia - few spermatozoa in semen
- Necrozoospermia - dead or immobile sperms
- Teratozoospermia - sperm with abnormal morphology
WHO criteria for normal semen
|Year||WHO 1999||WHO 2010|
|Volume||2 ml||1.5 ml|
|Concentration||20 million/ml||15 million/ml|
|Low Normal Range||50%||32%|
For all male factor infertility, ICSI is the ultimate solution. In case of men with no sperms in the ejacuate but sperms present in the testis (obstructive azoospermia ), a testicular sample is taken, sperms are extracted and ICSI is performed.
Steps involved in IVF
1) Controlled Ovarian Stimulation
- Antagonist protocol:The female partner is given follicle stimulating hormone from day 2 to day 12 of her cycle (Cycle day 1 is the 1st day of periods) , the size of the follicle is monitored by ultrasound. Once the follicles grow more than 20 mm , an LH trigger or GnRh agonist is given for these follicles to mature.
- Long Protocol:On the 22nd day the cycle , the female partner is given a GnRh agonist , this assists the pituitary to release all the FSH and LH hormones ,thus starting early recruitment of follicles. On the 2nd day of the patients menstrual cycles ovarian stimulation starts , where more than one follicle is grown and once the follicles size becomes more than 20 mm, LH trigger is given and the oocytes are retrieved.
2) Oocyte Pick up /Ovum Pick up / Oocyte retrieval
The process of retrieving the oocytes from the grown follicle is known as oocyte pick up. This is a simple, scarless , ultrasound guided procedure. The ovum pickup needle gently aspirates the follicle from the ovaries under ultrasound guidance. This is also known as oocyte aspiration. This process takes about 30 minutes and is done under anesthesia. This comes under day care procedure , so the patient can go home in 4 to 5 hours. Oocytes are carefully picked form the follicular fluid and kept in a growth medium.
3) Sperm Preparation
The male partner is asked to give the semen sample using sterile techniques. This sample is then washed and processed using different techniques depending on the count and motility. Sperm extraction can also occur from the testis (TESA – testicular epididymal sperm aspiration) or PESA ( percutaneous epididymal sperm aspiration) or MESA( micro surgical epididymal sperm aspiration) or even micro TESE (microdissection testicular sperm aspiration)
In this step the eggs are cleaned and removed from the cumulous complex that contains the granulosa and the theca cells.
5) Intra cytoplasmic sperm Injection
The prepared semen sample and the oocytes are now added in the ICSI dish and one sperm is injected in each oocyte. The fertilised oocyte is then kept in the incubator to develop into an embryo.
6) Embryo Transfer
This is the final step of ICSI in which the embryos from the incubator are transferred into the mother’s uterus under ultrasound guidance.