ICSI or Intracytoplasmic sperm injection is one of the important treatment methods in infertility. It involves injecting live sperm into a person’s eggs in a laboratory to create an embryo or a fertilised egg. This type of method is more commonly used when there is male infertility issues in a couple.

Some of the most commonly asked questions are –

• What does intracytoplasmic in ICSI mean:

In ICSI, sperm is directly injected into the cytoplasm of the egg. This cytoplasm is a gel like substance in the centre made up of water, salt and other molecules.

• How is ICSI different from IVF:

IVF or In-Vitro Fertilisation involves placing thousands of sperm next to an egg/ova in a petridish in a laboratory and leaving the fertilisation to occur. Whether the sperm penetrates or fertilises the egg is left to chance. So there are many times when conception may not occur leading to failure of IVF cycle.
ICSI is a part of IVF. Here a single sperm is directly injected into egg. So the likely chance of conception is more when compared to traditional IVF.

• How successful is ICSI / What is the success rate of ICSI:

Success rate of ICSI is same as that of IVF. It’s estimated that 50% – 80% of ICSI results in successful conception.

• Who is the ideal candidate for ICSI:

ICSI is most useful in people experiencing male infertility. Your fertility expert might suggest ICSI if you have   –

• • • Inability to ejaculate
    • Block in male reproductive system
    • Low sperm count/ oligozoospermia / Azoospermia
    • Poor sperm quality
    • If there is retrograde ejaculation.
    • If there is failure of embryo formation by traditional IVF
    • The person supplying eggs is older than 35 yrs.
    • In case of using previously frozen eggs or sperms to conceive.
      
      
• Who performs ICSI:
• • ICSI is not performed by any general health care provider. This is a special procedure that requires your doctor to be a Gynecologist who is also a reproductive endocrinologist or a fertility expert who specializes in diagnosing and treating infertility.
    
    

• What are the preparations done before ICSI:

Before ICSI, your doctor must collect the eggs and sperm for fertilisation. For egg retrieval

Ovulation Induction / Ovulation stimulation is done first. Hormonal injections to stimulate the ovaries is given for 8 – 14 days. This causes the ovaries to produce multiple eggs at once instead of just one egg. Then a human chorionic gonadotropin (hcg) injection is given to assist with final maturation of the eggs

Egg retrieval – using a transvaginal ultrasound , the gynecologist inserts a thin needle from the vaginal wall into the ovaries under a mild anaesthetic. Then a suction device is connected to the needle to collect all the eggs.

On the same day, sperms are also collected as eggs. The person supplying the sperms should

• • Abstain from sex or masturbation (i.e no ejaculation) for a minimum of 3 days prior to collection.
  • Collected specimen (by masturbation) must be received in the laboratory within an hour from ejaculation.
  • Semen analysis is done on the sample to check for sperm volume, count, motility etc.
    
    
    

• What happens after ICSI:

After ICSI, the healthcare provider will monitor the fertilised egg in the laboratory for signs of successful fertilisation. Within 5-6 days, a healthy fertilised egg should divide into cells, forming a blastocyst that is examined under a microscope. Then the doctor will decide when is the ideal time for embryo transfer based on the blastocyst size etc. The embryo is transferred into the uterus through a catheter from the vagina using ultrasound. For pregnancy to happen, the embryo needs to implant or attach to the uterus. It is recommended to wait at least 2 weeks before doing the pregnancy test.

• What are the complications/risks of ICSI:
  • Damage to some or all the eggs during needle penetration
  • Failure in fertilisation can occur after the sperm injection
  • Increase in chance of twin/ multiple pregnancy when the doctor might transfer more than one embryo to increase your ICSI success rate.
    
    

• What is the cost of ICSI:

ICSI is a more complex and costly fertility treatment compared to the traditional IVF. However the overall cost can vary depending on several factors, including the clinic, location, number of cycles required, drugs used, additional tests and procedures done etc and may vary from couple to couple. However, on an average it might roughly cost anywhere between 1.5 – 3 lakh INR per cycle.

If you and your partner are having trouble conceiving a child, your fertility specialist might recommend ICSI. Talk to your healthcare provider about whether ICSI is the right fertility treatment choice for you. In case of any doubt, contact our doctor at SISU Hospital.