Intracytoplasmic sperm injection (ICSI)

During ICSI the sperm doesn’t have to travel to the egg or penetrate the outer layers of the egg. This means that it can help couples where the man’s sperm:

• Can’t get to the egg at all.
• can get to the egg, but for some reason can’t fertilise it.

ICSI is likely to be recommended if your spouse has:

• A very low or zero sperm count.
• A high percentage of abnormally shaped sperm.
• This can result in poor motility, which means the sperm can’t swim well.
• Sperm that can’t be ejaculated but can be collected from the testicles or from the duct where sperm is stored (epididymis).

This may be needed if your spouse has had an irreversible vasectomy or injury.Problems with getting an erection and ejaculating, due to spinal cord injuries or diabetes, for example.If you have tried IVF you may move on to ICSI if not enough eggs could be retrieved, or if eggs retrieved for IVF were not successfully fertilised.

ICSI isn’t the solution to every male fertility problem. If your spouse has a low sperm count as a result of a genetic problem, this could be passed on to any sons you have together. Your doctor will usually recommend that your spouse has a blood test before you start the ICSI cycle. You and your spouse may find should be offered counselling before and after taking the test, to help you through both the decision and the process. Your doctor could to refer you to a counsellor.

As with standard IVF treatment, you will be given fertility drugs to stimulate your ovaries to develop several mature eggs for fertilisation. When your eggs are ready for collection, you and your spouse will undergo separate procedures. Your spouse may produce a sperm sample himself by ejaculating into a cup on the same day as your eggs are collected. If there is no sperm in his semen, doctors can extract sperm from him under local anaesthetic.

Your doctor will use a fine needle to take the sperm from your spouse’s:

• EPIDIDYMIS: In a procedure known as percutaneous epididymal sperm aspiration (PESA), or
• TESTICLE: In a procedure known as testicular sperm aspiraction (TESA).

If these techniques don’t remove enough sperm, your doctor will try another tactic. He’ll take a biopsy of testicular tissue, which sometimes has sperm attached. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is carried out with a microscope.

TESE is sometimes carried out before the treatment cycle begins, and under local anaesthetic. The retrieved sperm are frozen. Any discomfort felt by your spousepartner should be mild and can be treated with painkillers.

After giving you a local anaesthetic, the doctor will remove your eggs using a fine, hollow needle. An ultrasound helps the doctor to locate the eggs. The embryologist then isolates individual sperm in the lab and injects them into your individual eggs. Two days later the fertilised eggs become balls of cells called embryos.

The procedure then follows the same steps as in IVF. The doctor transplants one or two embryos into your uterus and through your cervix using a thin catheter.

If you are under 40 you can have one or two embryos transferred. If you are 40 or over you can have a maximum of three embryos transferred if using your own eggs, or two if you’re using donor eggs. Extra embryos, if there are any, may be frozen in case this cycle isn’t successful.
Embryos may be transferred two to three days after fertilisation, or five days after fertilisation. Five days after fertilisation the embryo will be at the blastocyst stage. If you’re just having one embryo transferred (called elective single embryo transfer, or eSET), having a blastocyst transfer can improve your chances of a successful, healthy, single baby.

If all goes well, an embryo will attach to your uterus wall and continue to grow to become your baby. After about two weeks, you will be able to take a pregnancy test.

One cycle of ICSI takes between four weeks and six weeks to complete. You and your spouse can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You’ll go back anywhere between two days and six days later for the embryo transfer procedure.

The success rates for ICSI are higher than if you use conventional IVF methods. A lot depends on your particular fertility problem and your age. The younger you are, the healthier your eggs usually are, and the higher your chances of success.

The percentage of cycles using ICSI which result in a live birth are:

• 35 per cent if you are under 35.
• 29 per cent if you are between 35 and 37.
• 21 per cent if you are between 38 and 39.
• 14 per cent if you are aged between 40 and 42.
• six per cent if you are between 43 and 44.
• five per cent if you are over 44.

• ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you.
• If your spouse is too anxious to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI.
• ICSI can also be used to help couples with unexplained infertility, though experts haven’t found that ICSI makes pregnancy any more likely than standard IVF.
• ICSI doesn’t appear to affect how children conceived via the procedure develop mentally or physically.