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ICSI

Overview

ICSI or intracytoplasmic sperm injection is a special form of IVF. This variant on the conventional IVF treatment has been used since 1992.

01. Procedure
02. Who is considered for ICSI?
03. Preparation
04. Treatment
05. Risks

Procedure

ICSI treatment is actually an IVF procedure in which an extra treatment is carried out in the laboratory. The only difference lies in the way in which the sperm and the egg are brought together. In an IVF treatment, many sperm cells (several tens of thousands at least) are placed in the dish with the egg in the hope that one of the sperms can penetrate an egg. In ICSI, a selected sperm is injected directly into the egg. Due to the fact that in ICSI the egg is artificially penetrated, the chances of fertilisation are indeed high. The results of ICSI are good. In other words, the percentage of fertilised eggs and the pregnancy rate are just as high as after a conventional IVF treatment.

Who is considered for ICSI?

The advantage of ICSI is that only one suitable sperm cell is needed per egg, as a result, this method is an option for couples whose sperm quality is insufficient (less than one million motile sperm cells per ejaculate) for IVF treatment. Besides this, ICSI is used if egg cells have not or have been barely fertilised in a previous IVF procedure. An ICSI treatment has no added value for couples who are considered for regular IVF treatment.

Preparation

The full ICSI treatment is identical to the IVF treatment for the woman. For the man, the preparation is a little more extensive given that an extra sperm analysis is often required in advance. Depending on the outcome of the additional sperm analysis, the laboratory will advise whether a conventional IVF treatment can take place or whether an ICSI treatment also has to be scheduled. Besides this, an extra blood test can sometimes be carried out in order to perform a heredity test. Men who have less than one million motile sperm per ejaculate are examined for the incidence of hereditary fertility defects. This is done because this defect can be passed on again to male descendents through ICSI. If a defect is found, a consultation is first held with a heredity expert.

Treatment

The drug regime in an ICSI treatment is the same as that for a conventional IVF treatment, and the ultrasound check on follicle growth and follicle puncture are both done in the same way. The sperm is washed in a special solution that prepares it for fertilisation. In ICSI, a suitable sperm is chosen for each egg by the laboratory technician. This selected sperm cell is drawn into a thin glass needle under a microscope and injected into one of the egg cells. The actual injection process takes less than 30 seconds, and this is performed for all collected eggs that appear mature and normal.

  • Less than a minute after the needle is withdrawn, the egg returns to its original shape.
  • Within 18 hours the embryologist can tell whether fertilisation has occurred.
  • Within 24 to 72 hours the embryologist can tell whether the embryo is growing.
  • If fertilisation occurs, the transfer is made just as with conventional IVF treatment.

Risks

The same risks for the woman that exist in a conventional IVF treatment also exist for an ICSI treatment. Because the treatment has been available for less time than IVF treatment, less information is known about the long-term effects on the progeny. Given that a single sperm cell is selected in ICSI, there can no longer be a suggestion of natural selection. An egg that appears normal is always chosen in ICSI, but it is not possible to identify the best. But, if carried out in the right way, the egg does not appear to suffer any ill effects from being pierced.

Tens of thousands of children have been born following an ICSI treatment. At this moment, most studies show that ICSI children do not have a greater chance of a hereditary defect than children created in other ways. There is a slightly increased chance of the child having chromosome defects (1%), besides the chance ( 3%) of passing on defects associated with the male sex chromosome, (the Y-chromosome), which are often the cause of the mans fertility problem. As regards to mental development, one study in ICSI boys shows they are slightly behind at one year of age. Other studies do not confirm these findings. Further research into ICSI children will have to provide more information. There is however agreement that the development of ICSI offspring is comparable with IVF offspring.

Whenever a pregnancy occurs with the aid of ICSI, irrespective of your age, you can have a chromosome study carried out on the child. This can take place before the birth (chorionic villus sampling or amniocentesis) or after (umbilical cord). You can discuss this with your gynaecologist. This has to do with the fact that ICSI is still relatively new and not  much is known about it compared to regular IVF.

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Dates 2015

4 - 6
Dec

Annual Meeting of the Middle East Fertility Society

Location: Liege, Belgium
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