Decoding ICSI A Step-By-Step Breakdown

October 12, 2022

Decoding ICSI A Step-By-Step Breakdown

When it comes to treating sperm-related infertility in couples, intracytoplasmic sperm injection (ICSI) is used. A part of an assisted reproductive technology (ART), the ICSI treatment helps increase the chances of fertilization through injection of a high-quality sperm into an ovulated egg during the in vitro fertilization procedure. Once the embryo is hatched, it is carefully placed in the uterus of a woman partner.

With ICSI, severe male infertility, where there is little or no sperm released in the semen, is treated. The sperm collected from the male reproductive system are immature and unable to move about. Intracytoplasmic sperm injection can help you here to fertilize the egg.

When Should You Go for Intracytoplasmic Sperm Injection Treatment?

ICSI is performed in conjunction with in vitro fertilization (IVF) after repeated failures in conventional IVF cycles owing to severe male infertility. It is also commonly used when frozen eggs are used for fertilization, as well as for PGT or preimplantation genetic testing. Most fertility clinics today recommend ICSI with every IVF cycle despite several arguments against using it regularly. ICSI is used with IVF in severe male infertility cases such as:

  • Extremely low sperm count or oligospermia
  • Poor sperm movement or asthenozoospermia
  • Abnormally shaped sperm or teratozoospermia 

In case the male partner, who is producing sperm, have no sperm in ejaculation, testicular sperm extraction or TESE is used to retrieve his sperm. Where TESE is used to collect sperm, it asks for the use of ICSI to help fertilization. Other than male infertility, ICSI is considered to be a good option for: 

  1. The Next IVF Cycle if the Previous IVF Cycles Have No or Very Few Fertilized Eggs

There are instances when the IVF cycle fails owing to no or fewer fertilized eggs despite the retrieval of sufficient number of matured eggs and availability of healthy sperm. Your doctor may suggest ICSI in the next IVF cycle to increase the chances or pregnancy. This is usually done after discussing with you.

  1.  An IVF Cycle Where Frozen Sperm Is Used

ICSI is recommended in the IVF phase in case the thawed sperm is not active. Studies show that the outcomes of using ICSI in frozen sperm gives the same pregnancy success rate as with the fresh ones.

  1. Genetic Screening Using PGD

When preimplantation genetic diagnosis (PGD) is used for genetic screening of fertilized egg or embryos, regular IVF technique may lead to the sperm cells, which are not part of the fertilization, to be around the embryo. This may affect the PGD results. PGD testing is generally suggested if a genetic condition is present in your family, and you want to reduce the chance of passing it on to the baby.  The IVF with PGD procedures recommend ICSI as a suitable method for fertilization.

  1. A Fertilization Procedure Using Frozen Oocytes

Some women prefer to freeze their eggs when they are young for use later. Oocyte Vitrification can harden the egg’s outer shell making fertilization of the egg difficult in the IVF procedure. The ICSI treatment can help solve this problem for the healthy sperm is directly injected into the thawed egg to enable easy fertilization.

  1. Using In Vitro Maturation or IVM

The in vitro maturation or IVM technique is used, in which the eggs, before they fully mature, are collected from the ovaries to allow them to go for maturation in the lab. In the traditional IVF cycle, the IVM eggs may not fertilize, even if high-quality sperm are used. Nevertheless, using ICSI with IVF gives better chances for fertilization of the eggs retrieved using the IVM procedure. There are not enough studies conducted in this line.

When the situations mentioned above prove that IVF with ICSI can be the best available option to increase the pregnancy success rates through IVF, there are some controversies on using ICSI in tandem with IVF in cases such as:

  • Unexplained Infertility: There are no studies conducted to show that ICSI can help improve pregnancy rates in couples with unexplained infertility. Nevertheless, ICSI is suggested by doctors to try every possible way of helping couples become pregnant. 
  • Advanced Maternal Age: ICSI is sometimes recommended for women who are in advanced maternal age (AMA). There are no studies to show that AMA will affect fertilization rates, and hence, the use of ICSI in this case is hard to justify.
  • ICSI for Every Couple with Infertility:  Some fertility specialists are of the opinion that every couple with fertility problems should undergo the ICSI treatment to eliminate fertilization failure. Research shows that out of every 33 patients only one would find IVF-ICSI beneficial. The others would undergo the treatment without receiving any benefit.

Though the ICSI treatment provides better fertilization rates of eggs, using it along with IVF depends on your circumstances, and it is up to your fertility specialist.

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