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IVF with ICSI
New micromanipulation techniques, especially intracytoplasmic sperm injection (ICSI) have significantly improved chances for a successful pregnancy for many in vitro fertilization (IVF) patients. In an ICSI procedure, a single sperm is injected into a mature egg.
Candidates
Micromanipulation is useful for infertile couples with severe male factor infertility. This includes very low sperm counts (theoretically as low as a few sperm per ejaculate), very poor sperm motility (less than 10 percent), or very abnormal morphology (shape of the sperm). It can also be used for men with no sperm in the ejaculate (azoospermia), whether because of a failed vasectomy reversal, an obstruction, or production problems (non-obstructive azoospermia). Patients with a prior history of no fertilization in IVF cycles (presumably due to sperm factors) may also be appropriate candidates.
Benefits
ICSI increases the fertilization rate for couples with poor semen quality and makes it possible for men with no measurable sperm in the ejaculate to father a biological child.
Risks
Eggs may be damaged and not survive the ICSI process. Children born through ICSI because of severe male infertility factor may be more likely to inherit certain genetic conditions. Also, ICSI is still new enough that long term effects on offspring are uncertain, although preliminary results do not suggest any increase in abnormalities.
Procedure
The IVF laboratory will first perform a semen analysis to determine if ICSI is needed and appropriate. The couple prepares for a standard IVF procedure. After the eggs are retrieved, they will be processed in our IVF laboratory. In the standard IVF procedure, the eggs are mixed with the male partner's sperm. In IVF with ICSI, a single sperm is injected into each mature egg. On average, about two thirds of the mature eggs that are injected with a sperm will fertilize.
To improve implantation of embryos in the
uterus, we use assisted hatching on all embryos produced by ICSI.
Some of the embryos that develop are then placed into the woman's
uterus. The embryo transfer occurs three
or five days after the initial egg retrieval. Surplus good quality embryos
can be frozen for use in a frozen embryo transfer cycle.
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