INTRACYTOPLASMIC SPERM INJECTION (ICSI)

WHAT IS ICSI?

ICSI is a procedure whereby a single sperm is artificially inserted directly into the egg of a woman instead of penetrating the egg in the normal way. If it fertilises, this embryo is then replaced into the uterus of the woman with the intention of her becoming pregnant.

The ICSI procedure was developed in the early 1990’s by a team at the Brussels Free University Centre for Reproductive Medicine led by Prof. A Van Steirteghem. Fertilisation rates and pregnancy rates are similar to normal IVF pregnancy rates.

WHO CONSIDERS ICSI?

Approximately one man in 25 has sperm qualities which make it impossible for him to father children normally.

About 13% of these men have untreatable sterility many having no sperm at all. Some do produce sperm which are either not motile (do not swim) or do not have the normal shape and structures which are required for normal penetration of eggs. These men, plus a further 10% (approximately) who have either very low sperm counts, very low percentage of sperm being motile or a very large percentage of their sperm being abnormally shaped, or a mixture of these problems and whose sperm do not adequately fertilise eggs in normal IVF, would be likely to benefit from ICSI.

Where couples who have tried IVF and no fertilisation (or only occasional fertilisation) was achieved and where the cause of this reduced fertilisation rates can be attributed solely to the poor fertilising ability of the sperm, then couples will be offered ICSI. Where there are fertilisation rates less than 40% ICSI is the treatment of choice.

BENEFITS OF ICSI

ICSI is only suitable for attempting to achieve fertilisation where the sperm of the male partner are unable of achieving acceptable fertilisation rates using routine IVF. ICSI has been shown to achieve fertilisation rates of about 70%. ("Normal" sperm will fertilise about 70% of mature eggs in normal IVF).

ICSI has resulted in pregnancy rates which are similar to IVF success rates. These rates depend to a large extent on:

1. Age of the woman
2. Her infertility status and cause.
3. Number of embryos replaced.

Men whose sperm are unable to achieve adequate fertilisation rates in IVF now have the opportunity to father their own children with the use of ICSI, which would not have been possible any other way.

There is evidence that the incidence of abnormalities in foetuses and children resulting from ICSI procedures is no greater than in the normal population,

DISADVANTAGES OF ICSI

Some eggs might be damaged during the ICSI procedure. Should this happen these will not continue to fertilise or develop into embryos.

MANAGEMENT OF ICSI

ICSI is not required to be used unless it is absolutely necessary. Unless the sperm parameters of a man are so poor as to indicate that fertilisation of eggs in IVF is either very poor or not likely to occur, each couple where the male partner has suspect sperm quality will be advised to attempt a routine IVF procedure.

Couples for whom it is applicable, should also be required to attend a Genetics Counselling Session before commencing treatment.

ICSI/IVF TREATMENT CYCLE

All women are treated as for all IVF treatments (Refer In Vitro Fertilisation Fact Sheet).

Men will be required to provide a semen sample in the morning of the egg collection.

In the event a man is required to undergo aspiration of sperm from the testicles or epididymis, this will be discussed with him by his urologist first and the aspiration will be performed prior to the egg collection.

The sperm are then washed and prepared in a way that allows the sperm head to be able to break down to release its chromosomes once it is injected into the egg.

The egg is examined to ensure it is mature and a single sperm is drawn up into a very small glass injection pipette which is injected into the egg and the sperm is released.

The eggs are placed in culture and examined the following day to see whether they have fertilised normally.

The balance of the procedure is similar to IVF.