Among assisted reproductive technologies, IVF ICSI has one of the highest success rates. What is icsi (intracytoplasmic sperm injection, intracytoplasmic insemination), what are the indications for this procedure, a detailed description of the manipulation, side effects in the icsi treatment, as well as answers to all sorts of questions for future mothers and fathers – in this article.
What is ICSI: method description
Intracytoplasmic sperm injection (ICSI, intracytoplasmic insemination) is a type of in vitro fertilization (IVF), in which fertilization occurs by introducing the best quality sperm selected in the laboratory into the oocyte cavity. To carry out the manipulation, high-tech instruments are required: a microscope with 400x magnification, a glass microneedle for capturing the sperm, holding a capillary for fixing the egg, micromanipulators to which microinstruments are connected. For clarity, we will describe the ivf icsi procedure step by step:
- Puncture of the ovaries, as a result, the doctor removes oocytes.
- Selection of healthy eggs, removal of the protective shell from them, placement in a nutrient medium close to the natural one inside the woman’s body.
- Receiving, cleaning and freezing the ejaculate (in the absence of spermatozoa in it – obtaining them by puncture of the testicle).
- Obtaining sperm from thawed ejaculate / by puncture of the testicle.
- Selection under the microscope of the most morphologically (in appearance) perfect and motile spermatozoa.
- Separation of the tails and capture of the selected spermatozoa with a glass microneedle.
- Fixation of the oocyte with the help of the retaining capillary and the introduction of the sperm into its cavity.
- Placement of fertilized oocytes in a sterile medium heated to body temperature for 5 days.
- Selection and preimplantation genetic testing (PGT, PGD) of embryos.
- Transfer of 1-2 healthy embryos into the uterine cavity.
- Freezing (vitrification) of the remaining healthy embryos for subsequent possible transfers.
Note: Sometimes clients of reproductive clinics do not distinguish between ICSI and sperm injections for pregnancy (IUI, intrauterine insemination). In the second case, fertilization takes place in the woman’s body. The difference from natural conception is only in the method of delivery of sperm into the uterine cavity. For IUI, this is done using a catheter. Sperm injection for pregnancy is used as a method to overcome ovulation dysfunction, ejaculation disorders, sexopathologies, cervical infertility, poorly expressed fertilizing ability of ejaculate, vaginismus, in the absence of a woman’s sexual partner. Sperm injection for pregnancy makes it easy to overcome immunological infertility.
Now that the future parents have received detailed information on what icsi (intracytoplasmic insemination) is, we will list the medical indications and side effects of icsi injections. The technique is mainly aimed at overcoming the male factor of infertility, but it is also used in cases of infertility of unknown origin.
ICSI procedure for pregnancy: indications and contraindications for icsi treatment
The indications for the icsi treatment are mainly pathologies related to the male factor of infertility. Namely:
- Absence of mature sperm in the ejaculate (azoospermia);
- Low sperm count in the ejaculate (oligozoospermia);
- Insufficient sperm motility (asthenozoospermia);
- Morphological pathology of sperm(teratozoospermia);
- Poor sperm quality diagnosed after thawing;
- Unsuccessful IVF attempts;
- Antisperm bodies in the ejaculate;
- The need for PGD.
Future parents also want to know all about icsi side effects on the mother. Pregnancy as a result of ICSI can be accompanied by all the same reactions of the body, then achieved naturally. It will only require more careful monitoring for the timely appointment of supportive therapy. Possible icsi side effects on the mother:
- Nausea and vomiting;
- Stomach pain;
- Frequent urination;
- Shortness of breath;
- Allergic reactions;
- Vaginal bleeding;
- Sensitivity of the mammary glands;
- Sharp mood swings;
- Gestational diabetes;
- Syndrome of ovarian hyperstimulation;
- High blood pressure;
- Premature birth and low birth weight
- Multiple pregnancies.
The use of hormone therapy does not guarantee that icsi will have side effects on the mother. Their presence or absence largely depends on the health status of the future mother.
The probability of icsi treatment side effects is reduced if the method is performed in a natural cycle without the use of hormone therapy. This approach is possible in the presence of three key factors: a regular cycle, a young age of the future mother and male infertility. However, even in the absence of hormone therapy, icsi treatment side effects cannot be completely excluded.
Icsi success rates, icsi reasons for unsuccessful fertilization
Icsi success rates depend on a large number of factors, the age of the future parents, the state of health, the quality of the reproductive material (oocytes, sperm), the equipment of the reproductive laboratory and the qualifications of doctors, and other unpredictable factors. That is, the icsi reasons for unsuccessful fertilization can be either a consequence of insufficient treatment of the couple and diagnosis of the quality of the biomaterial, or be an accidental unpredictable factor (conception is a complex process, a failure can occur at any stage for a number of reasons). In a perfectly healthy couple, the chance of conception in each menstrual cycle does not exceed 25%.
IVF ICSI success rates are high relative to other ART methods, but rather low relative to the expectations of future parents – only 30-45%. However, under ideal conditions, icsi success rates are markedly higher than that of a healthy couple at natural conception. Despite the few impressive figures, the icsi procedure for pregnancy is the most progressive and effective method of treating infertility today.
Icsi reasons for unsuccessful fertilization are carefully analyzed by the doctor in order to increase the chances of success in the next IVF attempt. It is possible that in order to increase IVF ICSI success rates in a particular case, an extended examination and treatment will be required. With this method, even in difficult cases, it takes an average of three attempts for a couple to achieve pregnancy.
Icsi pregnancy procedure: preparation plan
Preparing for icsi treatment is no different from preparing for a standard IVF protocol. At the initial stage, a woman will need to undergo examinations, pass tests and assess the ovarian reserve. If there are not enough oocytes and they are of poor quality, this may need the use of donor eggs.
As already noted in the «ivf icsi procedure step by step», the technique allows you to select the most promising spermatozoa that can create a healthy embryo. The approach is also relevant in case of low sperm quality or lack of sperm. Only in the case of severe sperm pathology or a high risk of gender-linked genetic diseases, the doctor will recommend the use of donor sperm.
As with any other methods of fertility treatment, the best thing that future mothers and fathers can do is to trust the doctor and follow his recommendations. All other things being equal, this is the shortest way to a long-awaited pregnancy.