Intracytoplasmic Sperm Injection, commonly known as ICSI treatment, is an auxiliary form of IVF treatment. The ICSI treatment process is greatly helpful for couples seeking IVF treatment where the male partner has poor sperm motility and quality.
For infertile couples, fertility treatments are inevitable if they want a chance for conception. Undeniably, IVF treatment is the most conventional fertility treatment for various infertility factors. Numerous couples and individuals have achieved their dream of parenthood owing to IVF. IVF treatment processes often require additional assisted reproductive techniques like ICSI to succeed.
What is the ICSI Treatment Process?
Intracytoplasmic sperm insemination is a process of stimulated insemination of an ovum (egg) by a sperm. In this process, the sperm is manually injected into the cytoplasm of the ovum, and the rest of the procedure follows IVF treatment.
How Does the Process of ICSI Treatment Differ from Conventional IVF treatment?
ICSI is performed in conjunction with the conventional IVF treatment. In conventional IVF treatment, the eggs and sperm are put together in a culture medium in the hope that the sperm will penetrate and spontaneously fertilize the eggs. However, in the ICSI treatment process, the sperm is precisely injected into the oocyte’s (egg) cytoplasm (semifluid cell membrane) to carry out fertilization. ICSI increases the probability of fertilization. IVF treatment with ICSI is often referred to as IVF-ICSI.
Why is ICSI Treatment needed?
In cases where the male partner has a very low sperm count, poor sperm motility, or poor sperm quality, the sperm might not be able to fertilize an egg on its own and require assistance. In these cases, ICSI is needed to assist sperm to fertilise an oocyte or egg.
ICSI Treatment Process – step-by-step
The ICSI treatment process follows a similar procedure as IVF treatment; the only difference is the insemination techniques. First, your fertility doctor will refer to some necessary bloodwork, ultrasound and semen analysis to understand the cause of infertility. The fertility expert will construct a personalized IVF-ICSI program based on the diagnosis. The ICSI process follows as such:
- Ovarian Stimulation with Different IVF Protocols
In this step, hormonal medications stimulate the ovaries to produce more mature eggs per month. The medications also allow the fertility expert to control your ovulation cycle. There are different hormonal protocols known as IVF protocols for ovarian stimulation. The IVF protocols are specific to patients’ ovarian reserve. Commonly, there are two protocols; Long and short IVF protocols.
Ovarian stimulation involves administering GnRH hormonal injections containing FSH and LH for 10-12 days. By 5-6th, gonadotropin injections (hCG) are administered in a timely manner along with previous medications. At the end of the ovulation cycle, a last ‘trigger shot’ of gonadotropin (hCG) is prescribed to stimulate ovulation 34-36 hours before the egg pick-up.
- Follicular Aspiration or Egg Pick-up
The eggs are retrieved from the ovaries 34-36 hours after the “trigger shot” at the doctor’s clinic. The procedure hardly takes 30-40 mins and is usually performed under local sedatives. A needle guided by ultrasound is used to suck out fluid (containing mature ovum) from follicles through a suction device. It is a pain-free procedure; patients only feel minor cramping and discomfort after it.
The fluid is examined under a microscope so that mature oocytes (egg) can be located and collected in a nutritive culture for fertilization.
- Sperm Collection and capacitation
A fresh semen sample is collected from the male partner via masturbation on the same day of follicular aspiration. If they cannot provide a fresh semen sample, then frozen sperm or donor sperm can also be used.
The semen sample is then capacitated to separate semen plasma, and quality sperm are concentrated by microscopy or morphology of sperm. The goal is to concentrate at least one million sperm of good motility per millilitre of the semen sample.
In other severe male infertility factors, the sperms are retrieved from the testicles.
- Ovum denudation and Fertilization
Before insemination, the outer cellular layer of the mature eggs is to be removed. There are two methods for egg denudation in the IVF lab; enzymatic (chemical) and mechanical. And it is performed after a few hours of follicular aspiration once the eggs are fully matured.
For fertilization, a quality sperm is selected and crippled from its tail by the microinjection pipette. Then the sperm is aspirated in one microinjection, and another holding pipette holds the egg and both are placed under an inverted microscope.
The ovum is gently introduced to the sperm through microinjection. The microinjection pipette will suck out some cytoplasm inside the egg, and sperm will combine with cytoplasm, which will be gently released back into the egg. The inseminated eggs are then evaluated for quality and placed in a culture medium inside an incubator for fertilization, which takes approximately 24 hours.
- Embryo Development
After fertilization, the embryos are monitored for multicellular and genetic development in the laboratory. Only a quality embryo has a chance for implantation; therefore, evaluating embryos for quality control is necessary. Generally, 2-3 day embryos are used for transfer as they have developed into multicellular cells. They are assessed for different features, and only healthy embryos are selected through morphology or genetic screening.
In some cases, Blastocyst cultures are used for transfer. A blastocyst is a 5-6 day embryo (50-150 cells) more differentiated into cells than a day 2-3 embryo (8-16 cells). The blastocyst can be more easily implanted in the uterine wall as its outer layer is very thin.
- Embryo Transfer
After 3-5 days of fertilization, the embryo(s) is transferred to the uterus for implantation. How many embryos should be transferred is decided by fertility doctors and patients themselves. Note that more than one embryo transfer has a higher chance of multiple implantations and hence multiple pregnancies.
The embryo transfer process is simple and performed under mild or no anaesthesia. The embryos are placed in a catheter tube, and the tube is then inserted inside the vagina into the uterus. The embryo(s) is gently placed on the right spot with the help of ultrasound. And then, we wait for them to implant and grow into a fetus.
Pregnancy Test: Approximately two weeks after the embryo transfer, the pregnancy tests are carried out. Your hCG levels are measured through blood tests for the confirmation of pregnancy.
In what cases is ICSI Treatment required?
ICSI is typically performed to overcome male factor infertility such as:
- Very low sperm count
- A large portion of sperm are slow
- Abnormal shape and size of sperm
- In the case of Azoospermia and erectile dysfunction
- In case of vasectomy
- If a couple has a history of recurrent IVF failure
- In cases where female partners has anti-sperm antibodies
- The male partner has a genetic disorder
ICSI Treatment Process at Risaa IVF
We provide IVF-ICSI Treatment to couples with previous IVF cycle failure at cost-effective prices and high success rates of 50-58%. Our fertility doctors are vastly experienced in IVF, ICSI and other ARTs infertility treatments, and we have been helping couples to achieve parenthood for 30+ years. We have medically advanced IVF laboratories and proficient embryologists to perform ICSI and embryo assessments.
Contact us to learn about ICSI Treatment and to get the treatment, or visit Risaa IVF, Green Park, Delhi.
Does ICSI increase the IVF success rate?
ICSI influences the success rate of IVF in a positive direction. In men with poor sperm motility, their sperm doesn’t fertilize eggs in a conventional IVF treatment, and even if fertilization occurs, the quality of embryos developed is often poor. ICSI increases the occurrence of fertilization for these conditions by 50-80%; therefore more quality embryos can be developed. Nevertheless, the success rate depends on multiple factors and not only fertilization. So, there are no evidence that ICSI has higher success rate than IVF.
What is the Cost of IVF Treatment with ICSI?
Conventional IVF treatment costs are expected to be between 1.5 to 2.5 lakh. And ICSI treatment can add extra numbers to the cost. IVF centers offer different IVF packages for different infertility treatments. The cost of treatment varies from clinic to clinic according to the facilities provided.
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