What is ICSI?

This refined and advance technique first stepped in the ART world in 1992, with the help of which first ICI baby was born on 14/01/1992. It was invented by Professor André Van Steirteghem in the Centre for Reproductive Medicine at the Vrije Univesiteit Brussel, Belgium.

ICSI is intracytoplasmic sperm injection technique where one morphologically normal spermatozoon is selected in washed semen sample that is injected in oocyte by puncturing zona pellucida and allow to fuse to form zygote on next day. It is a most suggested method of treatment for couple with male infertility problems or having history of IVF failure despite of all normal diagnosis.

The process of ICSI enhances the chance of fertilization in couple facing problem in conceiving especially with severe male fertility factor. There are various male factors that effects the pregnancy outcome in couple such as

1. Male infertility having minimal/low sperm count than standard (WHO) value (oligozoospermia), poor motility of sperms (asthenozoospermia) and with morphologically abnormal head shaped with or without neck defects (teratozoospermia).
2. Female with poor/low ovarian reserve should opt this technique to secure their fertilization during IVF treatment.
3. Female with advance maternal age >=35/F must go with ICSI than conventional IVF to get better fertilization rate and leading higher chance of pregnancy.
4. Obstruction in male reproductive duct having no sperms in semen (azoospermia) obstructive or non-obstructive and absence of seminal fluid after ejaculation (aspermia) can go for ICSI. But in such cases sperms are priorly retrieved from by surgical method TESA (Testicular Sperm Aspiration) or PESA (Percutaneous Epididymal Sperm Aspiration).
5. Couple with history of IVF failure with the conventional IVF though all diagnosis were normal. In such cases despite of normal diagnosis in couple are not able to attain pregnancy, where sperm are selected by IVF expert and ICSI is done.

How ICSI is done?

1. Here female is firstly stimulated with hormonal injections and medication to stimulate follicles by which is naturally able to produce single mature oocyte but with the support of medications multiple follicles are developed.
2. When the female is ready for OPU they are triggered before 36hours of oocyte retrieval and then one date is fixed as per advised by doctors in Aashakiran fertility World.
3. On the final day of OPU female oocytes are retrieved under short duration of general anesthesia. The IVF doctor will extract out follicular fluid under the guidance of ultrasound with the help of OPU needle.
4. Then the follicular fluid is assessed under microscope to retrieve oocytes from follicular fluid. After that oocytes are kept in culture media for incubation in incubator in 37°c.
5. Meanwhile, male sample is collected on the day of OPU procedure which is collected via ejaculation in a sterile container. In some exceptional case (azoospermia or aspermia) IVF doctor have to extract out sperm by TESA/PESA under local anesthesia to make the procedure less painful. Then the collected/extracted sample is washed by IVF expert.
6. Then IVF expert select morphologically normal single sperm from the sample which is injected inside oocyte under inverted microscope allowing clear visualization of oocyte and sperm.
7. After fertilization embryo transfer is planned accordingly after examination of female done post-OPU to check optimal value of hormone. The embryo transfer is done on day2, day3 or day5 after fertilization where number of embryos may vary as per stages and grades of embryos.
8. Embryo transfer is done once everything is fine with female after OPU is decided by IVF doctor. Then under sterile condition embryo transfer is performed where embryos are placed into uterine cavity (below uterine fundus) with the help of catheter.
9. Once embryo transfer is completed post ET patients are counselled by an IVF doctor. Then after 15day βHcG blood test is done to confirm implantation of embryo in uterus.

Moreover, ICSI along with DFI can reduce the chances of chromosomal abnormality in children. Also, being an advance method fertilization rate is enhanced with the help of ICSI.