ICSI is short for intracytoplasmic sperm injection. This is a specialized technique aimed at improving pregnancy rates resulting from IVF treatment. The ICSI method was developed around 1991 at the Vrije Universteit (Free University) of Brussels, Belgium. The technique has become available in fertility clinics in the United States during the last couple of years.

How ICSI Works

ICSI basically involves injecting sperm directly into an egg. This is done during the stage of the IVF process just after the eggs have been harvested, namely, when the eggs are being fertilized in a laboratory. In a regular IVF procedure, sperm cells from the semen sample provided by the male partner (or a sperm donor) are put into a special dish along with the egg cell, in the hope that one of the sperm cells will manage to penetrate and fertilize the egg. In ICSI, the ability of the sperm cell to penetrate the egg is not left to up to chance - the injection ensures that this part of the process is successful. ICSI does not, however, always guarantee fertilization or pregnancy. The fertilization rate is somewhere between 75 % and 80%. Studies have found that ICSI does increase pregnancy rates resulting from IVF. Other experts have said that the technique needs be in use for a longer period of time before conclusions can be drawn. Fertility clinics that don't use the technique have been quick to point out that they select the healthiest sperm cells to use for egg fertilization, meaning that injecting one of these sperm cells into an egg is not a necessary step.

ICSI Procedure

The ICSI procedure is similar to the IVF procedure until the fertilization stage. Before then, the female partner has to use drugs to suppress her natural ovulation and then stimulate her ovaries into producing several mature eggs at one time. These eggs are then harvested and are ready for fertilization in the laboratory. Alternatively, an egg donor can be used. Sperm cells are taken from a semen sample provided by the male partner or by a sperm donor. When it comes to fertilization, a microscope is used to guide a specialized hollow needle, which picks up an individual sperm cell and injects it through the outer shell of the egg and into the cytoplasm on the inside. Only the best quality sperm cell(s) in the semen sample are used for this purpose. The next morning, the egg will be checked to see if fertilization has occurred. If so, one or more embryos are transferred into the uterus, in the hope that they will implant and that a pregnancy will result.

ICSI Candidates

At the moment, ICSI is not offered to all IVF couples. Qualifying criteria and availability vary from fertility clinic to fertility clinic, but here are some general guidelines as to who is likely to benefit most from the technique:

Couples who have a low egg yield after the eggs have been harvested, because through ICSI, the eggs they do have may stand a better chance of being fertilized.

Couples whose inability to conceive is due to reduced fertility of the male partner. This includes men with low sperm counts, men who have poor quality sperm (poor motility or morphology), men who have had irreversible vasectomies, and men who have become infertile after receiving treatment for testicular cancer (provided they had their sperm cells frozen before treatment).

Ask Your Specialist

If your problem is male factor infertility, ICSI may help. The fact the technique is used to pick out only those sperm cells that have a good chance of fertilizing an egg means that your chances of getting pregnant may be increased. Also, men who have problems ejaculating may still benefit from the technique, as sperm cells can be removed directly from the testicles. Ask your fertility specialist for more information.

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