How Does Intracytoplasmic Sperm Injection (ICSI) Treatment Work?

Why is ICSI done?
Typically, the ICSI method is used in cases of severe male fertility, including oligospermia (low sperm count), teratozoospermia (abnormally shaped sperm) and asthenozoospermia (poor sperm movement). It can also be used in the following cases:

Frozen sperm being used -
ICSI may be recommended when the thawed sperm does not appear especially active.

PGD -

When a preimplantation genetic diagnosis (PGD) is being done, ICSI is recommended since, with regular fertilization techniques, sperm cells can hang around the embryo and interfere with accurate PGD results.

Few or no fertilized eggs during the previous IVF cycle – Sometimes, eggs don’t get fertilized despite healthy sperm count and plenty of retrieved eggs. In that case, ICSI can be tried during the next IVF cycle.

Frozen oocytes being used –
Sometimes, vitrification of eggs can cause the egg’s shell to harden. This can complicate fertilization. However, this can be overcome with ICSI.

In vitro maturation (IVM) –
When eggs are retrieved from the ovaries before they mature completely, this process is known as in vitro maturation. The final stages of maturation of these eggs happen in the laboratory. Studies have shown that IVM eggs might not be fertilized at rates similar to that of traditional IVF eggs. Thus, IVM might be a good option if done with ICSI.
ICSI treatment has a quite high success rate. In India, the ICSI success rate is 70 to 80 per cent.

How is ICSI done?
BirthRight Fertility by Rainbow is the top IVF hospital in Hyderabad. At BirthRight Fertility by Rainbow, expert embryologists use special equipment to perform ICSI treatment.

Sperm collection –
Sperm may be collected through masturbation. If that is not possible due to issues with sperm development or problem with sperm ejaculation due to a blockage, sperm would be surgically removed from a testicle through an incision. For men with little to no sperm in their semen due to other reasons, it is recommended that they get genetic testing done to screen for genetic problems that could affect offspring.

Ovulation and egg retrieval –
For ICSI, the woman would have to get her shots daily and be monitored for two weeks before retrieval of eggs. She would have to take FSH (follicle-stimulating hormone) or gonadotropin, for stimulation of her ovaries for the production of multiple eggs. This is known as superovulation. The doctors at BirthRight Fertility by Rainbow will check the blood estrogen levels as well as check if the eggs are growing and maturing using an ultrasound, after the first week. Based on the ultrasound and test results, the dosage might be changed in the second week. If the follicles develop fully, then she would be given a human chorionic gonadotropin (hCG) shot to stimulate the the maturation of ovarian follicles. 34 to 36 hours later, the mature eggs would be collected through needle aspiration via ultrasound through the belly to the ovaries or laparoscopy.

Sperm injection and transfer –
Once the mature eggs have been retrieved, one of the eggs would be held in place using a glass tool. One sperm is injected into this egg using a tiny glass tube. After being kept in the lab overnight, the eggs would be checked to see if fertilization has occurred. Fertilized eggs or eggs that have had 4 to 5 days to develop further are then selected after incubation. After this, one or more fertilized eggs are placed in the uterus.

How much does the ICSI treatment cost?
ICSI cost in Hyderabad ranges between Rs. 2,40,000 and Rs. 2,50,000 per cycle, however, it might vary depending on other factors.

What are the risks associated with the ICSI procedure?

1.With a normal pregnancy, there is a 1.5 to 3 per cent risk of major birth defects. With ICSI babies, the risk of birth defects, although rare, is slightly increased.

2.In less than 1 per cent of babies conceived using ICSI with IVF, birth defects such as Angelman Syndrome, sex chromosome abnormalities, Beckwith-Wiedemann syndrome and hypospadias might occur.

3.A male baby conceived through ICSI with IVF might have fertility problems in the future as male infertility might be passed on genetically.

4.There is always a risk of multiple pregnancies depending upon the number of embryos that are transferred into the woman’s uterus.

Is there a difference in the quality of the embryo or rate of pregnancy between non-ICSI and ICSI embryos?
There appears to be no difference in the rate of pregnancy between ICSI and non-ICSI embryos. Similarly, no difference has been shown in the overall embryo quality achieved with ICSI embryos as compared to non-ICSI embryos.