ICSI

ICSI stands for intracytoplasmic sperm injection. This method of infertility treatment is one of the auxiliary methods of in vitro fertilisation (IVF). It is used to overcome different forms of male infertility. For the first time this method was used in Belgium, in the Center for Reproductive Medicine of Brussels Free University, in 1992. Today more than 200 thousand ICSI programs are being carried out in Europe (2/3 of all IVF cycles).

In Reproductive Medicine Center Vera it has been carried out since 2008.

Absoluteindicationsfor ICSI:

  1. Absenceof male gametes in ejaculate (azoospermia). When dealing with obstructive forms of male infertility,gametes are obtained surgically from the testicle or the
  2. epididymis (TESA, MEZA)
  3. Decreased sperm concentration (less than 2 million per ml) (oligospermia)
  4. Decreased sperm motility (less than  1 millionin 1 ml ofejaculate) (asthenozoospermia)
  5. Spermpathology – decreased quantity of male gametes of normal morphology (less than 5%) (teratozoospermia)
  6. Combined forms of sperm pathologies.
  7. Presence of sperm-reacting antibodies in ejaculate. Even given anormal sperm concentration sperm-reacting antibodies impede natural fertilization (MAR-testmore than 50%)

Relative indications for ICSI are the following: poor fertilization of oocytes or unsuccessful fertilization in previous IVF attempts, immunoinfertility,     unexplained infertility, woman’s age over 38, using sperm after cryoconservation, and preimplantation diagnosis necessity.

Thereby, the decrease in spermogram values to the limits, when male gametes are not able to penetrate into the oocyte by themselves to fertilize it, is the indication for ICSI as the auxiliary method of IVF.

ICSI technique

ICSI procedure for women does not differ from that of a standard IVF protocol (multifollicular ovarian stimulation, follicle puncture and embryo transfer are the same as in the course of IVF). Only embryonal stage is different.

ICSI is carried out on the day of oocyte aspiration, or the next day in case if aself-sustained fertilizationhas failed. This procedure is conducted only on mature oocytes (radiating crown cells are preliminarily removed by way of fermentative or physical treatment), having first polar cell.

One male gamete, obtained from ejaculate or from thetesticle or the epididymis surgically, is enough for fertilization of one oocytein the process of ICSI. A male gamete of a high quality is chosen under the microscope. Then it is immobilized by way of cutting its tail by a microneedle. Obtained gamete is taken into the microneedle, which injects it into the inner part of the oocyte held by a micropipette. All the oocytes, obtained from the follicle puncture, are fertilized in the same way.

Stages of ICSI procedure:

  • Male gamete immobilization – immobilizationof single sperm by means of cutting its tail.
  • Male gamete suction into a microneedle.
  • Oocyte stabilization on a micropipette.
  • Oocyte piercing by the microneedle with further suction of a small quantity of ooplasm.
  • Male gamete and ooplasm injection into the oocyte.

Fertility rate after ICSI

There exists a probability that any of the oocytes will not be fertilized. This can be connected with both - ICSI procedure complexity (probable oocyte damage) and gametes quality, as a male gamete that looks qualitative and has a good mobility and normal morphology can at the same time have chromosomal anomalies. ICSI result (as well as the result of the whole IVF program) is also influenced by qualitative characteristics of oocytes.

Thereby ICSI outcome is influenced by two conditions: availability of qualitative oocytes and obtaining active sperms from the man’s ejaculate or the testicle.

ICSI success is not essentially influenced by the severity of male infertility and such values as mobility, quantity and morphology of male gametes.

Genetic risks of ICSI

Embryos obtained from ICSI have normal capacity for development, and children born after IVF with ICSI application do not differ from the ordinary children in their mental and physical abilities.

That is ICSI itself cannot lead to fetus genetic disorders, but in the course of ICSI an oocyte can be fertilized by a male gamete with genetic disorders (precisely those that lead to the spermatogenesis disorder). To reduce the risk in the solution of this problem it is necessary to use the method of preimplantation diagnosis for revealing genetic (or chromosomal) abnormalities of a concrete embryo at the stage of 6 and more blastomeres, and also to reveal genetic disorders before ICSI with the help of preliminary genetic screening.

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