Intracytoplasmic Sperm Injection

In 1992, a revolutionary new reproductive technique was developed that would allow men who suffered from significant fertility problems to have biological children. This breakthrough was intracytoplasmic sperm injection (ICSI).

What’s So Great About It?
Previous to ICSI, the only options to couples where the male partner had a low sperm count, a complete absence of sperm in his semen, a damaged or even absent vas deferens, an irreversible vasectomy or a host of other problems was to adopt, use a sperm donor or deal with the possibility of never having children. Understandably, many couples did not care for these limited options.

Using micromanipulation technology, ICSI allows fertility specialists to fertilize an egg using just one sperm. While it is preferred to use sperm from a semen sample, specialists can retrieve sperm from the testicles if it is necessary. Once sperm has been collected, the specialist will draw a single sperm into a needle and inject it directly into an egg that has been collected from the female partner through the usual retrieval methods. This process bypasses the conventional IVF methods of fertilization, thereby ensuring that fertilization has taken place. The fertilized eggs are then left to culture for a few days before being transferred back to the woman’s uterus. ICSI is always used alongside IVF.

Who is Suited to ICSI?
Couples that are infertile due to any of the following reasons may want to consider using ISCI with their IVF treatment.

• Low sperm count
• Poor sperm motility
• Abnormally high amount of morphologically atypical sperm
• Experienced fertilization failure for unknown reasons in a previous IVF cycle
• Lack of any sperm in ejaculate due to CAVD, failed vasectomy reversal, failure to produce sperm, or an obstruction in the epididymus due to past inflammation
• Retrograde ejaculation
• Immunological factors

Additionally, men who have been diagnosed with testicular cancer may choose to freeze a semen sample before undergoing treatment as this can later be used in ICSI.

Success with ICSI
While the fertilization rates with ICSI remains pretty high at between 60% and 70% depending on the quality of sperm used, pregnancy rates remain about the same as they do with IVF. Approximately 20% to 25% of couples undergoing ICSI and IVF will have a live birth. However, one concern among many experts is how healthy this procedure is for the resulting children.

Because ICSI is used mainly in men with extremely poor sperm quality, the fact that it allows an egg to be fertilized with any sperm, rather than the strongest, has caused concern that congenital defects may be passed on at a greater rate. Additionally, it is a relatively new procedure and the long term effects in children conceived through ICSI have yet to be properly analyzed. However, so far no studies have shown that children conceived with ICSI do have any increase in congenital defects. If there is a known risk of genetic diseases or disorders in your family, though, you may want to consider using PGD.

Moreover, because ICSI is used alongside IVF, couples undergoing this treatment do have an increased risk of ectopic pregnancy as well as multiple births.

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