Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI)
ICSI – which stands for Intracytoplasmic Sperm Injection – involves the direct injection of a single sperm into each egg under direct microscopic vision. The introduction of ICSI has made it possible to fertilize eggs with sperm derived from men with the severest degrees of male infertility and in the process, to achieve pregnancy rates as high, if not higher than those that can be achieved through conventional IVF in non-male-factor cases. In traditional In Vitro Fertilization, an egg is placed in a Petri dish with several hundred thousand sperm, where it is fertilized (hopefully) by a motile, morphologically normal sperm cell. With ICSI, all that is needed is a single sperm of reasonable morphologic quality. Motility is no longer a major factor in fertilization, since the sperm is carried to the egg and injected directly into it.
In fact, even when there is an absence of sperm in the ejaculate such as occurs in cases of congenital absence of the Vas deferens (when a man is born without these major sperm collecting ducts), in cases where the vasa deferentia (ducts that carry the sperm from the testicles to the urethra for ejaculation) are obstructed (such as following vasectomy or trauma), in some cases of testicular failure, or where the man has impotency, ICSI can be performed with sperm obtained through Testicular Sperm Extraction (TESE), or aspiration (TESA). In such cases, the birth rate is usually no different than when IVF is performed for indications other than male infertility. The successful performance of ICSI requires a high level of technical expertise by the embryology lab. SIRM performs ICSI on virtually 100% of IVF cases in our onsite laboratory facilities.
There seems to be quite a bit of speculation about the rate of birth defects associated with children conceived through ICSI fertilization. Here are some facts:
- The performance of ICSI in cases of male factor infertility has been shown to slightly increase the risk of certain embryo chromosome deletions (leading to a slight increase in early miscarriages).
- There is some evidence that there is an increased potential for a resulting male offspring to have male infertility in later life
- There is no evidence of any significant increase in the incidence of serious birth defects attributable to the ICSI procedure itself.
- More relevant is the fact that when ICSI is performed for indications OTHER THAN male fertility issues there is NO reported increase in the risk of subsequent embryo chromosome deletions, miscarriages or in the incidence of subsequent male factor infertility in the offspring.
- Another major advantage of doing conventional ICSI is that it affords the opportunity to remove the complex of cells that envelop the harvested egg (cumulus) and so enable the embryologist to evaluate microscopic paramaters that point to maturity. This cannot be done with conventional IVF as the removal of these cells would virtually preclude conventional fertilization in the petri dish.
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