What is ICSI?
• ICSI is an acronym for intracytoplasmic sperm injection
A fancy way of saying "inject sperm into egg"
• 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.
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.
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