ICSI

ICSI - Is It For Us?

Before taking this important decision, you must ask yourself a few questions as a couple:

• Does the male partner have a low sperm count?
• Is the motility of the sperm exceptionally low?
• Are the sperm cells morphologically sound?
• Is the male partner vasectomised?
• Does the male partner experience trouble achieving erections or ejaculating?
• Does the male partner have diabetes, spinal cord injury or any other reproductively debilitating problems?

If yes, then ICSI might just be the solution you're looking for.

How Does the ICSI Procedure Work ?

ICSI works almost exactly like the IVF procedure, except the fertilisation process. In IVF the fertilisation process happens in a disc but in ICSI the sperm is injected in the egg individually using a machine called micromanipulator.

What Are The Steps Leading Up To ICSI?

For women :

• Fertility drugs like gonadotrophin are administered.
• The eggs are collected
• Collected eggs are injected with healthy, washed and highly potent sperm and left to be fertilised at low temperature.
• The embryo is transferred to the uterus.

For men,the steps are:

• Sperm examination to determine suitability for fertilisation.
• If suitable sperm is available; a sample is taken the natural way and individual sperm cells are injected into the egg.
• If not sperm is extracted directly using a micro syringe the epydidymis (a narrow tube inside the scrotum). This method is called PESA (percutaneous epididymal sperm aspiration). Other methods are TESA-testicular sperm aspiration, and TESE

What Are The Success Rates In ICSI?

Intra Cytoplasmic Sperm Injection

Until the 90's males with very low counts (less than 5 million per ml) or poor quality sperms had no hope of fathering children. This problem was surmounted by the new breakthrough of ICSI, which took place in Brussels, Belgium in 1992.

Since then, many such patients have fathered a child.

In ICSI all the steps are similar to the procedure of IVF, except the step of fertilisation. Normally in IVF one egg is mixed with 100,000 sperms and one of the sperms fertilises the egg on its own. In contrast, in ICSI each egg is held and injected with a single live sperm. This micro-fertilisation is done with the help of a machine called the Micromanipulator.

Infertility India, clinic provides comprehensive affordable ICSI treatment and services. ICSI Centre in India, Our clinic deals in Infertility treatment which includes ICSI treatment

Thus the procedure consists of:

• Controlled Ovarian stimulation with drugs (GnRH Analogues and Gonadotrophins) to produce many eggs.
• Monitoring of follicles and egg development with the aid of vaginal sonography and serial Estradiol hormone estimation.
• Administration of hCG injection, (Human Chorionic Gonadotrophins) when the two leading follicles are 18mm in diameter.
• Oocyte or egg retrieval under short general anesthesia 35 to 37 hours after HCG injection.
• Identification and isolation of eggs in the laboratory.
• Sperm collection and processing in the lab. Incase of azoospermia (no sperms in the semen) the sperms are collected directly from the testis with the procedures of PESA/MESA/FTNB/TESE or TESA.
• Dissection of the eggs in the laboratory with the help of an enzyme called Hyloronetis. Placement of eggs into small droplets of culture media under oil.
• Placement of sperms into small droplets of PVP under oil. Immobilization of the sperm with a micro-injection needle (Diameter of 7 microns) and aspiration of the immobile sperm into the needle (tail first).
• Holding the egg with a holding pipette and injection of the immobilized sperm into the held egg Placement of these eggs into the incubator for 2 to 5 days.
• Embryo formation 2 to 5 days after fertilisation.
• Embryo transfer of good quality embryos back to the womb, after 2 (four cell embryo), 3 (six-eight cell embryo)or 5(blastocyst stage) days after egg removal.

Indications :

• Males with severe sperm factors such as low count (less than 5 million), very poor motility or high degree of abnormal sperms.
• Males with azozoospermia, where there is no sperm present in the semen. The azozoospermia may be of the obstructive type where there is production of sperms in the testis but blockage of the conduction system which brings the sperm out into the semen. Alternately, the azoospermia may be of the non-obstructive type, where there is a failure of the testis to produce sperms. Nowadays, in both these types of azoospermia, sperms can be isolated directly from the testis, using the SPERM
• Retrieval Techniques of PESA/TESA/TESE and subsequently, ICSI can be performed on:

Males with sperm anti-bodies.

Males with ejaculated dysfunction due to spinal chord injury or malfunction such as quadriplegics or paraplegics.

Patients with retrograde ejaculation (ejaculation of the sperm into the urinary bladder) who fail to become pregnant with IUI.

Patients where fertilisation has failed with In Vitro Fertilisation.

In our unit we also believe in doing ICSI on patients who have had previous history of tuberculosis or endometriosis as we believe it gives better fertilisation rates than standard IVF (this is a personal experience not supported by international literature).

Nowadays, some units are advocating routine ICSI for all patients, including those with normal sperm counts. We do not believe in such practice as we feel that pregnancy should be achieved with minimum handling of the gametes outside the body. If the sperm count is good enough for fertilisation with IVF, we will not do ICSI. However, if a particular patient has a sperm count which is in the grey-zone area, then we may subject half the eggs to IVF and half the eggs to ICSI.

Concept:

Similar to IVF, ICSI differs in the fertilisation process. Unlike in IVF, where one egg is mixed with 1 lakh sperms, with fertilisation taking place on its own, ICSI is a technique where each egg is held and injected with a single live sperm. This micro-fertilisation is done with the help of a machine called the Micromanipulator. The procedure (anchor) can be categorised into 11 steps.

Indications for ICSI ICSI is a technique usually performed in males with:

Severely low sperm counts
Poor quality of sperms
ICSI and Babies and Us
Pioneered in Brussels, Belgium in 1992, Babies and Us brought the technique to India in 1995.

In ICSI all the steps are similar to the procedure of IVF (procedure of IVF), except in fertilisation.

Procedure:

Controlled Ovarian stimulation with drugs (GnRH Analogues and Gonadotrophins) to produce many eggs.

Monitoring of follicles and egg development with the aid of vaginal sonography and serial estradiol hormone estimation.

Administration of hCG injection, (Human Chorionic Gonadotrophins) when the two leading follicles are 18mm. in diameter.

Oocyte or egg retrieval under short general anaesthesia, 35 to 37 hours after HCG injection.

Identification and isolation of eggs in the laboratory.

Sperm collection and processing in the lab. Incase of azoospermia (no sperms in the semen) the sperms are collected directly from the testis with the procedures of PESA/MESA/FTNB/TESE or TESA.

Dissection of the eggs in the laboratory with the help of an enzyme called Hyloronetis Placement of eggs into small droplets of culture media under oil.

Placement of sperms into small droplets of PVP under oil. Immobilisation of the sperm with a micro-injection needle (Diameter of 7 microns) and aspiration of the immobile sperm into the needle (tail first).

Holding the egg with a holding pipette and injection of the immobilized sperm into the held egg Placement of these eggs into the incubator for 2 to 5 days.

Embryo formation 2 to 5 days after fertilisation.

Embryo transfer of good quality embryos back to the womb, after 2(four cell embryo), 3 (six-eight cell embryo)or 5(blastocyst stage) days after egg removal.

Indications :

• Males with severe sperm factors such as: low count (less than 5 million) very poor motility high degree of abnormal sperms. Although ISCI is carried out among patients even with normal sperm counts, Babies and Us believes that pregnancy should be achieved with a minimum handling of the gametes outside the body. If a particular patient has a sperm count that is in the grey-zone area, then we may subject half the eggs to IVF and half the eggs to ICSI.
• Males with azoospermia have no sperm present in the semen. The azoospermia may be of the obstructive type where there is production of sperms in the testis but a blockage in the conduction system disallows sperms to enter the semen. Alternately, the azoospermia may be of the non-obstructive type, where there is a failure of the testis to produce sperms. Fortunately, today, sperms can be isolated directly from the testis, using the Sperm Retrieval Techniques of PESA/TESA/TESE and subsequently, ICSI can be performed.
• Males with sperm anti-bodies.
• Males with ejaculated dysfunction due to an injury to the spinal chord or in quadriplegics or paraplegics.
• Patients with retrograde ejaculation (ejaculation of the sperm into the urinary bladder) who fail to allow pregnancy under.
• Patients where In Vitro Fertilisation has proved to be unsuccessful.
• At Babies and us, ICSI is performed for on patients with a history of tuberculosis or endometriosis as we believe ICSI shows higher fertilisation rates than standard IVF (this is a personal experience not supported by international literature).

Dr. Nandita Palshetkar is a fertility specialist in Mumbai, India, who combines clinical experience with modern IVF technology in infertility treatment. For more information or consultation please write to info@nanditapalshetkar.com