What is ICSI treatment?
Did you know, around 15% of couples globally suffer from infertility problems, and nearly half of these problems are related to male infertility?
ICSI is a conventional treatment recommended for sperm-related issues and is performed as a specialized form of in vitro fertilization (IVF). The procedure involves the process of extracting a single sperm to inject into a single egg, maximizing the chances of fertilization. ICSI treatment bypasses the challenges that can occur for sperm to get through the egg wall.
Your doctor will usually recommend ICSI if you present the following problems:
- Low sperm count
- Abnormally shaped sperm (poor morphology)
- Abnormal sperm movement (poor motility)
- Previous unsuccessful IVF treatment
- Sperm required for collection through a surgical procedure
- Frozen sperm is used in the treatment
- Embryo testing for genetic conditions
Myths & Facts About Infertility
Before we go into more detail about the ICSI procedure, let’s address some myths commonly associated with fertility treatments.
- Myth: Conceiving a second baby will be easier
Fact: Some couples may have no trouble conceiving a second child. However, millions can struggle with secondary infertility, according to the National Center for Health Statistics. Various factors can relate to secondary infertility such as age, polycystic ovary syndrome, smoking, alcohol consumption, or being overweight.
- Myth: Women suffer from infertility more than men
Fact: A large percentage of infertility problems are male-related. Although men do not necessarily have a “fertile window,” there are certain factors that can affect women more than men, like age.
- Myth: If a man can ejaculate it means he is fertile
Fact: If a man ejaculates, it does not mean he is fertile. This could be because he has a low sperm count, low-quality sperm, or no sperm at all. It is better to get an analysis for a better understanding of sperm count and quality.
- Myth: Age doesn’t affect the chances of having a baby
Fact: Age is a huge factor that contributes to the success of fertility treatments and the chances of conceiving. By the age of 40, women only have a 5% chance of having a baby. Chances of conception can decline rapidly in women in their mid-thirties and older.
- Myth: You can have twins or triplets through IVF treatment
Fact: There is an increased chance of having twins and triplets through IVF, but the majority of women produce a single child. 21% of pregnancies through IVF produce twins and 1% result in triplets. This can happen due to the transfer of multiple embryos during treatment to increase the chances of pregnancy.
What is the difference between ICSI and IVF treatment?
It can be quite confusing, but ICSI is a form of IVF treatment which follows pretty much the same procedure. However, there is only one difference between the ICSI and IVF process.
IVF mixes multiple sperm with the eggs to increase the chances of fertilization. ICSI involves a skilled embryo specialist, known as an embryologist, to inject a single sperm into individual eggs to improve fertilization chances, especially for sperm-related problems and if previous IVF attempts have failed.
How does ICSI work?
Similar to IVF treatment, ICSI requires a treatment cycle to be carried out. The process starts with the administration of fertility drugs, like follicle-stimulating hormones (FSH) and luteinizing hormone (LH), to help stimulate the ovaries to produce multiple eggs for fertilization.
Vaginal ultrasounds are used to monitor follicle development for mature eggs. This can usually take 8-14 days.
Other medications to prevent premature ovulation, like human chorionic gonadotropin (HCG), may also be given by your doctor.
A sperm sample is collected, through ejaculation. If there is no sperm present in the semen, the doctor may have to surgically collect a sample using a fine needle, using either of these techniques:
- Percutaneous Epididymal Sperm Aspiration (PESA) where the sperm is extracted from the epididymis, which is a coil of thin tubes located in the scrotum and where sperm pass through.
- Testicular Sperm Aspiration (TESA), which obtains sperm directly from the testicle.
- Testicular Sperm Extraction (TESE) or micro-TESE are procedures carried out under general anesthetic. It involves taking a biopsy of the testicular tissue where sperm can sometimes be found.
Eggs are retrieved by transvaginal ultrasound aspiration, using a fine, hollow needle attached to an ultrasound probe.
Progesterone is given in either pessary or injection form to prepare the womb for egg transfer. Egg retrieval can cause cramping, light bleeding, and some soreness.
In the lab, the embryologist will isolate and inject a single sperm, using a tiny needle, called a micropipette. The egg is held in place with a holding tool. The sperm is inserted through the outer layer and into the cytoplasm (center) of each individual egg. The needle is then carefully removed. The eggs are kept in the lab until natural fertilization occurs, before transferring into the womb. The embryo (fertilized egg) is left in the lab for around one to five days until transfer.
Embryo transfer is usually done four to five days post egg retrieval. This stage involves the following procedure:
- Your doctor will provide a light sedative, although it is not often a painful procedure.
- A catheter, which is a long, flexible, thin tube is inserted into your vagina, through your cervix, and into your uterus.
- A syringe with a small collection of embryos is attached to the end of the catheter.
- The doctor uses the syringe to guide the embryo or embryos into your uterus.
You can go back to your daily routine post the embryo transfer procedure. However, try avoiding strenuous activities.
Common side effects include:
- Fluid discharge
- Breast tenderness
- Slight bloating
- Mild cramping
Contact your doctor if these symptoms persist or develop into severe pain. Your doctor will assess if there are any complications, like your ovarian torsion (twisting of ovaries) or an infection.
Two weeks after egg retrieval, your doctor will take a blood sample to find out if you are pregnant or not. A blood test is usually more accurate than a pregnancy test as it can detect lower levels of HCG.
One cycle of ICSI can take four to six weeks to complete.
Risks of ICSI Treatment
The ICSI treatment has some optimistic success rates that range from 50 – 80%. However, as it is a delicate procedure, there can be complications.
During the ICSI process, some eggs and embryos can get damaged, no longer making them viable.
There is also an increased chance of giving birth to multiples. Couples following the ICSI treatment are 30 – 35% more likely to produce twins and have a 5-10% increased chance of having triplets.
Benefits of ICSI Treatment
Fertilization rates may be slightly higher using ICSI, but pregnancy rates for both IVF and ICSI are the same.
A lot of factors like age, the actual fertility problem, and overall health can influence your chances of getting pregnant and having a healthy pregnancy.
Here is a table highlighting some success rates, below:
|Age (Years)||Success Rate (%)|
|18 – 34||44%|
|35 – 37||39%|
|38 – 39||30%|
|40 – 42||21%|
|43 – 44||11%|
|45 & over||2%|
Fertility treatment can be complicated and stressful. It is essential to consult your doctor to understand your options. The success of any fertility treatment depends on a lot of factors, so be sure to provide as much information as you can during your consultation. Both you and your partner should undergo necessary tests to identify problems and start planning the best course of treatment moving forward.
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