INTRACYTOPLASMIC SPERM INJECTION [ICSI]
ICSI assists in male infertility, where there is defect sperm quality, intracytoplasmic sperm injection ( ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low.
INTRA CYTOPLASMIC SPERM INJECTION - (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. Medical treatment with clomiphene, hormones, antioxidants, coenzyme-Q haved been tried with varying degrees of success.
Intra-cytoplasmic sperm injection, commonly referred to as ICSI, is a well-established microinjection technique, which has resulted in additional options for patients in the treatment of their infertility.
ICSI involves the insertion of a single selected sperm directly into the cytoplasm of a mature egg, bypassing all the preliminary steps of sperm binding.
This procedure overcomes many barriers to fertilisation which can include failed fertilisation from repeated use of conventional IVF, severe male factor infertility, very low sperm counts and/or motility, high number of morphologically abnormal sperm, utilisation of surgically retrieved sperm, use of frozen sperm when limited in number and quality.
The first human pregnancy with ICSI was reported in 1992 and since this time thousands of babies have been born as a result of the ICSI procedure, providing many couples with hope previously not available.
In ICSI all the steps are similar to the procedure of IVF, except the step of fertilization. Normally in IVF one egg is mixed with 100,000 sperms and one of the sperms fertilizes the egg on its own. In contrast, in ICSI each egg is held and injected with a single live sperm. This micro-fertilization is done with the help of a machine called the Micromanipulator.
The Procedure Consists Of :
- Controlled Ovarian stimulation with drugs (GnRH Analogues and Gonadotrophins) to produce many eggs.
- Monitoring of follicles and egg development with the aid of vaginal sonography and serial Estradiol hormone estimation.
- Administration of hCG injection, (Human Chorionic Gonadotrophins) when the two leading follicles are 18mm in diameter.
- Oocyte or egg retrieval under short general anesthesia 35 to 37 hours after HCG injection.
- Identification and isolation of eggs in the laboratory.
- Sperm collection and processing in the lab. Incase of azoospermia (no sperms in the semen) the sperms are collected directly from the testis with the procedures of PESA/MESA/FTNB/TESE or TESA.
- Dissection of the eggs in the laboratory with the help of an enzyme called Hyloronetis. Placement of eggs into small droplets of culture media under oil.
- Placement of sperms into small droplets of PVP under oil. Immobilization of the sperm with a micro-injection needle (Diameter of 7 microns) and aspiration of the immobile sperm into the needle (tail first).
- Holding the egg with a holding pipette and injection of the immobilized sperm into the held egg Placement of these eggs into the incubator for 2 to 5 days.
- Embryo formation 2 to 5 days after fertilization.
- Embryo transfer of good quality embryos back to the womb, after 2 (four cell embryo), 3 (six-eight cell embryo)or 5(blastocyst stage) days after egg removal.
