Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is
an assisted reproductive technology (ART) used to treat sperm-related
infertility problems. ICSI is used to enhance the fertilization phase of in
vitro fertilization (IVF) by injecting a single sperm into a mature egg. The
fertilized egg is then placed in a woman's uterus or fallopian tube camera.
If sperm cannot be collected by means of
masturbation, they are surgically removed from a testicle through a small
incision. This method may be used when there is a blockage that prevents sperm
from being ejaculated or when there is a problem with sperm development. To
screen for genetic problems that could affect offspring, experts recommend that
men with little or no sperm in their semen (not due to a blockage) have genetic
testing before they start ICSI.
To prepare for a procedure using your own
eggs, you must get daily shots and be closely monitored for 2 weeks before the
eggs are collected. At home, you or your partner injects you with gonadotropin
or follicle-stimulating hormone (FSH) to stimulate your ovaries to produce
multiple eggs. This is called superovulation. After the first week, your doctor
checks your blood estrogen levels and uses ultrasound to see if eggs are
maturing in the follicles. During the second week, your dosage may change based
on test results and ultrasound. If follicles fully develop, you are given a
human chorionic gonadotropin (hCG) shot to stimulate the follicles to mature.
The mature eggs are collected 34 to 36 hours later. This is done using
laparoscopy or needle aspiration guided by ultrasound through the belly to the
ovaries.
A glass tool is used to hold an egg in
place. A tiny glass tube is used to put one sperm into the egg. After culturing
in the lab overnight, eggs are checked to see if they've been fertilized. After
incubation, the eggs that have been successfully fertilized or have had 3 to 5
days to further develop are selected. One or more are placed in the uterus
using a thin flexible tube (catheter) that is inserted through the cervix. Your
doctor will recommend how many embryos to transfer, based on your age and other
information about you. The other embryos may be frozen for future use.
The shots, monitoring, and procedures for
in vitro fertilization (IVF) can be emotionally and physically demanding of the
mother. Superovulation with hormones requires regular blood tests, daily shots,
and frequent monitoring by your doctor. Some of the shots can be quite painful.
These procedures are done on an outpatient
basis. They require only a short recovery time. Your doctor may advise you to
avoid strenuous activities for the rest of the day.
ICSI is used to treat severe male
infertility, as when little or no sperm are ejaculated in the semen. Immature
sperm collected from the testicles usually can't move about and are more likely
to fertilize an egg through ICSI.
ICSI can be used even if a couple's
infertility is not related to a problem with sperm. Some couples choose to try
ICSI after repeat in vitro fertilization has not worked.
ICSI is also used for couples who are
planning to test the embryo for certain genetic problems. ICSI uses only one
sperm for each egg. So there is no chance the genetic test can be contaminated
by other sperm.
Used with in vitro fertilization and eggs
of good quality, ICSI often is successful for men who have impaired or no sperm
in the ejaculate. ICSI (using sperm collected from the testicles) produces an estimated
25% to 30% birth rate.
Risks related to ICSI are the same as for
in vitro fertilization.
