Intracytoplasmic sperm injection (simply a smart term for “injecting a sperm into an egg”). This is what you see on television when you see a needle being injected into an egg.
ICSI is the name of a procedure that is carried out to help couples with male infertility to conceive. It is carried out in addition to IVF. ICSI involves a member of the laboratory team injecting a single sperm into an egg to fertilise it.
Who is ICSI suitable for?
Fertilisation of an egg is a tough job for a sperm! In order to fertilise the egg, the sperm must first overcome a series of challenges. Firstly, it must be able to swim towards the egg. Secondly, it needs to be able to burrow its way though the tough outer coating of the egg to reach the central part (the cytoplasm). Once the sperm reaches the central part, it fertilises the egg and triggers the first division into two cells. These cells divide again and keep dividing until a tiny ball of cells is formed. This ball of cells is the earliest stage in the growth of a baby. It is called an embryo.
There are many problems that can prevent sperm from overcoming these challenges. For example, the sperm may be abnormally shaped or they may not be active enough to pierce the outer coat of the egg. There may simply be too few sperm in the ejaculate (semen). This is known as a “low sperm count.”
A semen analysis (series of sperm tests) will be carried out if you and your partner are having trouble conceiving. If a problem is picked up in the semen analysis that is thought to be the cause of your difficulty, you may be diagnosed with male infertility.
ICSI was developed to help couples with male infertility to conceive. It allows the sperm to bypass some of the challenges described earlier and makes it easier to fertilise the egg.
Your doctor at the Unit may also recommend ICSI if you have tried IVF before, but the treatment was not successful because the eggs did not fertilise, or fertilised abnormally.
What does ICSI involve?
You will need to have some blood tests carried out before treatment can begin. This is because some men suffer from genetic conditions that cause male infertility. These genetic conditions need to be ruled out before treatment can begin, so that you can be given appropriate genetic counselling.
ICSI is carried out in addition to IVF. You and your partner will experience the IVF cycle the same as other patients who are not having ICSI. In a normal IVF cycle, the laboratory team will simply mix the eggs and sperm together and wait for fertilisation to occur naturally. In an IVF cycle with ICSI, the team will inject a single, good quality sperm into your partner’s egg to make fertilisation easier. The fertilised eggs (embryos) will then be transferred to your partner’s womb as normal.
If you have any questions about ICSI or the IVF process, staff at the Unit will be more than happy to answer them for you.
The ICSI process bypasses a natural selection process. For this reason, babies born as a result of treatment with ICSI have been followed up long term to see if the procedure is associated with any increased risks for children.
The short answer is that it is. If the reason for male factor infertility is genetic, then male children may inherit the same problem. There is also a small increase in fetal abnormalities, e.g. 2% of babies naturally conceived have a heart defect, 2.1% of babies conceived after ICSI have a heart defect. We will discuss this with you in more detail if we think this treatment is appropriate for you.
It is for this reason that the Hull IVF Unit only recommends ICSI treatment when there is a valid indication. Currently about 50% of cycles involve the use of ICSI.