ICSI Treatment Is The Master Of  The Male Infertility

The ICSI treatment in India is particularly useful in conceptive prescription, making parenthood feasible for men with sperm issue. On the off chance that a sperm neglects to treat the egg normally or amid IVF, this is generally in light of the fact that the sperm neglects to infiltrate the egg's external and internal layer. Basically we can say that this treatment is the master treatment for the male infertility and every year more than 2% of men are dealing with the problem.

Intra Cytoplasmic Sperm Injection (ICSI) is the infusion of a solitary sperm specifically into the cytoplasm of the egg. Who requires ICSI? Understanding who have low sperm number, extremely poor motility or a high rate. The achievement rate of IVF-ICSI.

What Is ICSI?

ICSI Treatment in India with Select IVF clinic Delhi
  • What is ICSI? ICSI is an acronym for intracytoplasmic sperm injection
  • ICSI is a very effective method to fertilize eggs in the IVF lab after they have been aspirated from the female
  • Its main use is for significant male infertility cases
  • IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to Select and pick up individual sperm in a specially designed ICSI needle.
  • The needle is carefully advanced through the outer shell of the egg and the egg membrane - and the sperm is injected into the inner part (cytoplasm) of the egg.
  • This usually results in normal fertilization in about 75-85% of eggs injected with sperm.
  • However, first the woman must be stimulated with medications and have an egg retrieval procedure so we can obtain several eggs for in vitro fertilization and ICSI.

Who Should Be Treated With Intracytoplasmic Sperm Injection?

There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not. Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes.

Our thinking about ICSI has changed over time, and we are now doing more ICSI (as a percentage of total cases) than we were 10-12 years ago. As we learn more about methods to help couples conceive, our thinking will continue to evolve.

Common Reasons Used For Performing ICSI

  1. Severe male factor infertility that do not want donor sperm insemination.
  2. Couples with infertility with:
    • Sperm concentrations of less than 15-20 million per milliliter
    • Low sperm motility - less than 35%
    • Very poor sperm morphology (subjective - specific cutoff value is debatable)
  3. Having previous IVF with no fertilization - or a low rate of fertilization (low percentage of mature eggs that were normally fertilized).
  4. Sometimes it is used for couples that have a low yield of eggs at egg retrieval. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (mixing eggs and sperm together).

How Is ICSI Performed?

  1. The mature egg is held with a specialized holding pipette.
  2. A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.
  3. This needle is then carefully inserted through the zona (shell of the egg) and in to the center (cytoplasm) of the egg.
  4. The sperm is injected in the cytoplasm and the needle is removed.
  5. The eggs are checked the next morning for evidence of normal fertilization.

Fertilization And Pregnancy Success Rates With ICSI

ICSI Treatment in India with Select IVF clinic Delhi

Fertilization rates for ICSI: Most IVF programs see that about 70-85% of eggs injected using ICSI become fertilized. We call this the fertilization rate, which is different from the pregnancy success rate.

Pregnancy success rates for in vitro fertilization procedures with ICSI have been shown in some studies to be higher than for IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quantity and quality) as compared to some of the women having IVF for other reasons.

In other words, the average egg quantity and quality tends to be better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs - as compared to cases with unexplained infertility. Some unexplained cases have reduced egg quantity and/or quality - which lowers the chances for a successful IVF outcome.

IVF with ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician.

Sometimes IVF with ICSI is done for "egg factor" cases - low ovarian reserve situations. This is when there is either a low number, or low "quality"of eggs (or both). In such cases, ICSI fertilization and pregnancy success rates tend to be lower.

  • This is because the main determinant of IVF success is the quality of the embryos.
  • The quality of the eggs is a crucial factor determining quality and viability of embryos.

In some cases, assisted hatching is done on the embryos prior to transfer, in order to maximize chances for pregnancy


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ICSI or Intracytoplasmic sperm Injection is offered to a couple when the semen sample does not fall within 'normal' parameters. This can be due to:

  • Oligozoospermia - Low number of sperm in the ejaculate
  • Athenzoospermia - Poor progression or movement of the sperm
  • Teratzoospemia - High numbers of abnormally formed sperm

Other couples that might be offered ICSI are those who have unexplained fertility, who have had an IVF cycle which has resulted in low or no fertilisation.

ICSI Treatment Stage 1

The first stage of treatment involves taking a nasal spray or subcutaneous injection of GnRH or Gonandotrophin releasing Hormone analogue. This drug temporarily stops the normal activity of the ovary so that ovulation does not occur when the ovaries are being stimulated. It shuts down the ‘normal’ ovarian function. Some women may experience side effects from the nasal spray or injection. These can be headaches, hot flushes or mood swings. The symptoms can be similar to that of PMT. The nasal spray or injection is taken for approximately two weeks. An ultra sound scan will then be performed to ensure that the ovaries are inactive.

ICSI Treatment Stage 2

Following the scan and confirmation that the nasal spray or injection has worked, the second drug will be introduced. These are administered by subcutaneous injection. These drugs are known as FSH or Follicle Stimulating Hormones. These will be administered on a daily basis and a scan will be scheduled between D6-D9 to check the response. FSH stimulates the ovaries to produce multiple follicles. The progress will be assessed by ultra sound scans. There can also be some side effects with these drugs such as tiredness, feeling bloated or breast tenderness.

ICSI Treatment Stage 3

ICSI Treatment in India with Select IVF clinic Delhi
The scan will be checking the response to the FSH injections. The follicles will be counted and measured. When the follicles are a certain size approximately 18mm, this indicates that there may be a mature egg present (unfortunately not all follicles will contain eggs). At this stage, depending on the number and size of the follicles will determine when the egg collection will be scheduled. If the ovaries have responded well to the FSH injections then another injection called HCG or Human Chorionic Gonadotrophin will be advised to be administered. This injection helps to mature the eggs present and to release the eggs in the follicles for the egg collection. It is advised that this injection is taken approximately 36 hours prior to the scheduled procedure. Normally after this injection all other drugs are stopped.

ICSI Treatment Stage 4- The Egg Collection

The egg collection or oocyte retrieval can be performed either under General Anaesthetic or sedation. It involves a vaginal probe, similar to the one that have been used in the vaginal scans, with a needle guide attached to it. The needle then, under ultra sound guidance, is passed through the vaginal wall into each ovary. The follicles are then individually drained and an embryologist checks the follicular fluid for eggs.

ICSI Treatment in India with Select IVF clinic Delhi

It is in the laboratory following egg collection that it differs. Instead of the sperm being placed with an egg for natural fertilisation to occur, ICSI involves a Selected single sperm injected directly into a mature egg. The eggs will then be placed in an incubator and checked the following day for fertilisation rates. The embryos are checked on day 2/3 of development. If they are progressing as expected then it may be recommended to aim for a blastocyst transfer on day 5. This can increase chances of a pregnancy.

ICSI Treatment in India with Select IVF clinic Delhi

ICSI Treatment Stage 5 - Embryo Replacement

It is at the embryo transfer that the discussion of the number of and quality of embryos to be replaced will take place. The embryo replacement normally takes place with no sedation. It is similar to a smear test in that a speculum is passed into the vagina. The vagina is then cleaned whilst the embryologist loads the catheter containing the embryos. A fine caterer containing the embryo/ embryos is passed through the cervix and into the uterus. The embryo's are deposited in the uterus. This is performed under ultra sound guidance. A pregnancy test should be performed 14 days after Embryo transfer.

ICSI Treatment in India with Select IVF clinic Delhi
4 Cell Embryo

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Progesterone

Progesterone helps to maintain the thickness of the lining of the uterus to aid implantation. The lining will have been increasing as a result of the FSH injections. This drug will be taken in the form of intra- muscular injection or suppository prior to or commenced on the day of the embryo transfer and continued until the pregnancy test.

Cryopreservation of Embryos

Following an IVF or ICSI cycle couples may have spare embryos that are of a good quality. The unit may then offer to cryopreserve the embryos for a frozen embryo replacement cycle.

The embryos have to be of a certain quality otherwise they will not survive the freezing or thawing process. Therefore not all couples will be offered freezing at the embryo replacement cycle. Some of the criteria the embryologists will be looking for are:

  • Number of cells present in the embryo
  • The number of cells correlating to the development stage of the embryo
  • Degree of fragmentation in the embryo
  • Number of embryos available for freezing-There may be a minimum number of embryo’s that a unit will freeze

Once the embryos have been preserved then they can be stored by the unit until a couple are ready to proceed with another treatment cycle.

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