Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) is a specialised form of IVF designed for cases of male infertility. In this process, a single sperm is injected directly into an oocyte (egg) to enhance the chances of successful fertilisation.
Who Can Benefit from ISCI:
- Repeated IUI failures.
- Advanced maternal and paternal age.
- Infertility associated with fragmented sperm DNA.
- Low sperm count, poor motility, or abnormal morphology.
Advanced Sperm Selection Techniques for ICSI:
The sperm contributes half of the genetic material in an embryo, making its quality crucial for successful implantation. Improved sperm selection techniques can enhance the likelihood of choosing structurally intact and mature sperm with high DNA integrity for fertilisation.
- Hyaluronic Acid Binding: Sperm that can bind to hyaluronic acid—a protein found on the outer layer of the oocyte—indicates maturity and intact DNA. This technique, known as PICSI (Physiological ICSI), selects sperm that have a normal physiological reaction.
- IMSI (Intra-Cytoplasmic Morphological Selected Sperm Injection): This method uses magnification of over 6000x to assess sperm for abnormalities, allowing the selection of the best candidates based on their morphological criteria.
Procedure Steps:
- Medical Assessment: The couple undergoes a thorough medical examination, including ultrasound assessments, blood tests, semen analysis, and any other necessary evaluations.
- Controlled Ovarian Hyperstimulation (COH): COH typically begins on the 2nd or 3rd day of the menstrual cycle. The woman’s pituitary function is suppressed using GnRH analogue or antagonist, while gonadotropins are administered to stimulate the ovaries to produce multiple follicles containing oocytes.
- Monitoring Ovarian Response: The growth of the follicles is monitored through ultrasound. The dosage of gonadotropins may be adjusted to achieve optimal ovarian response. Once the follicles reach the appropriate size, an hCG injection is given to induce oocyte maturity and ovulation.
- Egg Retrieval (OPU): Oocyte Pickup (OPU) is performed 34-36 hours after the hCG injection. Under sedation and using ultrasound guidance, the oocytes are aspirated from the follicles. This procedure typically lasts between 30-60 minutes, and the woman is required to fast for 6-8 hours beforehand.
- Semen Collection: A fresh semen sample is collected from the husband on the day of OPU. The sample is analysed and processed to select motile sperm for use in IVF-ICSI. If the husband may have difficulty providing a sample, a frozen sample should be stored in advance.
- Sperm Injection: The couple’s oocytes and sperm are combined to create viable embryos. The choice between IVF or ICSI for fertilisation depends on sperm quality. If the sperm quality is poor, advanced sperm selection techniques with ICSI are recommended.
- Embryo Culture: The fertilised oocytes are cultured until they develop into embryos. Regular assessments of embryo development help in selecting high-quality embryos.
- Embryo Transfer (ET): Depending on the woman’s age and prognosis, one to three embryos may be transferred into the uterus. If conditions are not suitable for transfer, the embryos can be frozen for future use.
- Luteal Support: Progesterone pessaries, injections, and/or hCG injections may be administered to enhance the uterine lining and assist in embryo implantation.
- Early Pregnancy Test: A blood test for beta hCG is recommended 12-14 days after embryo transfer to confirm pregnancy.
