The Science of Making Babies

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a special fertilization technique that is sometimes used along with the other ART procedures. It involves the injection of a single sperm directly into the center of an egg. The resulting embryos are placed back into the woman’s uterus, using a technique exactly like IVF.

WHY DOES ICSI WORK BETTER THAN NATURAL INTERCOURSE?

ICSI is more effective than natural intercourse because:

• Fertility medications are used to produce more eggs than would develop naturally.
• Instead of your having to wait for the eggs to ovulate naturally, with IVF the eggs are retrieved manually by your doctor.
• IVF bypasses the fallopian tubes because the eggs are retrieved directly from the ovaries and transferred directly into the uterus.
• Your eggs are treated in the laboratory, and their outside protective layer is removed to make them more easily penetrated and fertilized by sperm.
• Sperm are specially prepared in the laboratory and then injected directly into each of your pretreated eggs to greatly improve the chances of fertilization.
• Most IVF programs transfer several fertilized eggs back into your uterus to improve the chances of a successful pregnancy outcome.

CAN ICSI HELP YOU?
Although IVF can be successfully used for men with mild sperm abnormalities, ICSI has brought a new dimension of therapy for men with severe male factor infertility issues. Indications for ICSI include:

• Extremely low sperm count
• Poor sperm quality (abnormal shapes and poor movement)
• Presence of antisperm antibodies
• History of poor fertilization during one or more prior IVF attempts
• Any reason why the man’s sperm cannot easily penetrate the woman’s egg

WHAT ABOUT THE WOMAN’S ROLE IN ICSI?

Because ICSI is really designed for severe male factor infertility, as a woman, you may or may not have a fertility condition yourself. But as a couple, of course, you are both affected. As a woman, you will likely undergo IVF or another similar ART procedure to become pregnant.

HOW IS ICSI PERFORMED?

The ICSI procedure refers to the process of how the sperm fertilizes the egg and is typically performed in conjunction with another ART, such as IVF. The remainder of the steps are usually identical to IVF or another ART technique that your doctor may recommend. Because most of the time ICSI is performed in conjunction with IVF, the steps of these procedures are almost identical.

• Ovulation stimulation
• Egg retrieval
• Sperm collection and preparation
• Fertilization
• Embryo monitoring
• Embryo transfer
• Follow-up after ICSI
• Cryopreservation after ICSI
Ovulation stimulation and egg retrieval follow the same steps as in the IVF procedure.

HOW SUCCESSFUL IS ICSI?

The success rate for ICSI is usually about 30 percent. This is essentially the same pregnancy rate as with IVF. However, this is a signifi cant achievement because ICSI is primarily used in cases of severe male infertility. The success of the ICSI technique takes the anonymous sperm donor out of the picture, which eases much of the emotional diffi culty that couples have when dealing with an outside third-party sperm donor.