ICSI-Intra Cytoplasmic Sperm Injection is a technique by which a single sperm is injected into the egg to aid fertilisation process to make the embryo (fertilised egg).
There are 2 ways to fertilise the eggs in the laboratory. The conventional insemination-IVF in which the eggs and sperm are mixed in a petri dish and the sperm spontaneously enter the egg to bring about fertilisation. However, in certain situations such as low sperm count when normal fertilisation may not occur, ICSI is done to facilitate fertilisation.
ICSI is offered in the following situations
- Abnormally low sperm count
- Sperm showing poor motility
- Very high proportion of abnormal looking sperm
- Previous failed/poor fertilisation with IVF
- Sperm obtained from testis-surgical sperm retrieval
- Unexplained subfertility
- Very low number of eggs/poor quality eggs
When the eggs are retrieved, they are surrounded by supporting cells called cumulus. With ICSI, the embryologist removes these surrounding supporting cells by placing them in special solutions and then mechanically using special pipettes to isolate the egg.
The egg is then placed in customised dishes under the microscope of the micromanipulator-machine used to perform ICSI in special droplets. The egg is then held by a special holding pipette and a single sperm is then selected under the microscope by the scientist and loaded inside the injection pipette which is then introduced into the egg thus depositing the sperm inside the egg. We basically perform all the work for the sperm by depositing it inside the egg.
From the patient’s perspective, there are no changes in the protocol it is exactly the same as for IVF. In the lab, we use the micromanipulator to perform ICSI to facilitate fertilisation.
The healthy sperms have an oval head, a good midpiece and a long tail for motility. In men with poor sperm quality, these healthy sperms are very few in number and hence it is important to select a structurally good sperm to achieve better results with fertilisation.
The sperm is prepared and placed in special dishes in viscous solutions to slow them down and then the most normal looking sperm is selected, immobilised using the glass pipette and then sucked into the injection pipette ready to be injected.
Our embryologists are experts in choosing the right sperm and sometimes spend hours to select normal looking sperm (samples obtained from testis where there is no ejaculated sperm) to perform ICSI.
At KIMS fertility centre, the team uses additional techniques such as IMSI (Intracytoplasmic morphologically selected sperm injection) where necessary to select better sperm. Additional advanced techniques such as calcium to activate the egg and sperm activation agents are also used in certain situations to improve the outcome of ICSI and our embryologists have been trained in all the latest techniques to optimise the outcome for our patients undergoing ICSI.
ICSI provides a safe and effective way of fertilising the egg which would not have fertilised otherwise. Very little damage if any is incurred by the egg when performed by our very experienced embryology team who are veterans in this field. All the fertilised eggs are then placed in the incubator for further growth and development.
The pregnancy rates are similar with IVF and ICSI. However, ICSI is a boon and has revolutionised the treatment of male infertility in that even men with few thousands of sperm or men with no sperm in semen (azoospermia) are also able to get their own genetic child using this technique.