Intracytoplasmic sperm injection ( ICSI) is a laboratory procedure developed to help infertile couples undergoing in vitro fertilization(IVF) due to male factor infertility. Normaly in IVF, each egg is mixed with about a lakh sperms and one of the sperms enters the egg on its own . In ICSI, a single live sperm is injected in the egg by a special machine called the micromanipulator .
" Very low number of sperms (less then 5 million),very poor motility.
" Severe teratospermia .
" Problems with sperm binding to and penetrating the egg.
" Antisperm antibodies thought to be the cause of infertility.
" Prior fertilization failure with standard IVF methods.
" Frozen sperm limited in number and quality.
" Obstruction of the male reproductive tract not amenable to repair. Sperm may then be obtained from the epididymis by a procedure called microsurgical epididymal sperm aspiration (MESA), or from the testes by testicular sperm aspiration (TESA).
" Males with ejaculatory dysfunction due to spinal disease or injury
" Retrograde ejaculation
The initial investigations of the couple and hormonal injections to produce a large number of eggs are the same as in conventional IVF. After the eggs are collected and identified by the embryologist, the outer layer of cells around each egg, known as the cumulus oophorus is removed so as to view the egg clearly. The eggs should be at a mature (M2) stage. The procedure is done under a microscope using micromanipulation devices (micromanipulators, microinjectors and micropipettes ). A holding pipette on the left stabilizes the mature oocyte. From the opposite side a thin, hollow needle is pierced through the oolemma and into the inner part of the oocyte. It is loaded with a single sperm that will be released into the oocyte. The oocyte is checked on the following day for signs of fertilization.
The goal of performing ICSI is to minimize the risk of fertilization failure. At our centre ,we are using ICSI back up to ensure fertilization in cases of unexplained infertility also.When sperms are in reduced number or have abnormal morphology and motility, the function of the sperm can be significantly impaired. ICSI overcomes these problems by placing a single sperm within the egg.
Fertilization occurs in 50%to 80% of injected eggs. Approximately 30% of all ICSI cycles performed result in a live birth . Younger patients may achieve even more favorable results.
The wonder of ICSI lies in the fact that it allows many infertile couples to become parents of their own genetically -related children, as an alternative to Donor Insemination or adoption.