ICSI – intra-cytoplasmic sperm injection
The microsurgical fertilisation technique of ICSI is currently the most advanced technique available for the treatment of male infertility. It is used in conjunction with IVF and involves an extremely precise microscopic surgical procedure on an egg to assist fertilisation.
ICSI can be used in cases where the man produced only a very small number of sperm which are incapable of penetrating the barriers surrounding the egg unassisted. This is usually because the sperm have extremely poor movement or no movement at all. ICSI is also mandatory when sperm is directly retrieved from the testes.
Why is ICSI Done?
ICSI is typically used in cases of severe male infertility, including:
- Very low sperm count (also known as oligospermia)
- Abnormally shaped sperm (also known as teratozoospermia)
- Poor sperm movement (also known as asthenozoospermia)
If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE. Sperm retrieved through TESE require the use of ICSI.
ICSI is also used in cases of retrograde ejaculation, if the sperm are retrieved from the man’s urine.
ICSI may also be done if regular IVF treatment cycles have not achieved fertilization.
What is the Procedure for ICSI?
ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won’t seem much different than an IVF treatment without ICSI.
As with regular IVF, you’ll take ovarian stimulating drugs, while your doctor will monitor your progress with blood tests and ultrasounds. Once you’ve grown enough good-sized fillicles, you’ll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle.
Your partner will provide his sperm sample that same day (unless you’re using a sperm donor, or previously frozen sperm.)
Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved.
If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval.
PICSI- physiological intracytoplasmic sperm injection
In the ICSI procedure, an individual sperm is selected and injected into an oocyte. Until now, the only technique available to embryologists to select the sperm has been visual observation. Using PICSI procedure we are able to determine sperm selection in much the same way it happens in human biology.
Sperms are placed in PICSI dish containing samples of hyaluronan hydrogel. Hyaluronan is a naturally occurring biopolymer found in all human cells, including the gel layer surrounding the oocyte.
Mature, biochemically competent sperm bind to the hyaluronan where they can be isolated by the embryologist and used for ICSI. This procedure mimics a key step in the natural fertilization process, the binding of mature sperm to the oocyte complex. As a result, the selected sperm is essentially the same as one that would be successful in the natural reproductive process.
The research proved that hyaluronan-bound PICSI-selected sperm are, in the vast majority of cases, more mature, exhibit less DNA damage, and have fewer chromosomal aneuploidies.