Intra Cytoplasmic Sperm Injection (ICSI)

ICSI has been the greatest advance in human reproduction since in Vitro Fertilization, because many couples with very severe male factor problems who had previously been compelled to turn to sperm donation or adoption can now achieve pregnancy thanks to this treatment. The steps for this technique are similar to the ones described for IVF, but instead of inseminating eggs with a quantity of motile spermatozoa, only one is chosen (remember that in these cases there are very few motile spermatozoa) and injected into the egg, then transferring the embryos into the woman’s uterus. This technique was created in Belgium in 1992 and has been developed in Argentina since 1994.

Procedure Steps

It basically consists of 4 steps:

1) Ovarian stimulation, with the purpose of producing a significant number of eggs so as to secure the formation of 2-4 embryos, which will give a good chance of pregnancy with low chances of multiple pregnancy.

2) Egg retrieval, by means of a transvaginal ultrasound transducer fitted with a puncturing device.

3) Insemination of each egg with a single spermatozoon, which is done at the CEGYR laboratory. These inseminated eggs are kept in a heater from 2 to 5 days until the embryos are formed.

4) Embryo transfer, consisting in depositing the embryos into the woman’s uterus through the vagina, with a very fine catheter introduced into the cervix.
As you can see, ICSI is wholly performed through the vagina, thus not requiring an “operation” or “surgery”.

ICSI Patients

This technique that, as explained, consists in injecting a single spermatozoon into the egg cytoplasm using a glass needle, is performed in the following cases:

1) Very severe male factor disorders, like Oligo-Asteno-Teratozoospermia, in which sperm concentration, motility or morphology are not adequate for inseminations or in vitro fertilization. In order to perform an ICSI, 3-10 spermatozoa are enough (one per each egg to be injected). The quantity required for an ICSI procedure is minimum as compared to normal semen samples, which contain approximately 200,000,000 spermatozoa.

2) Azoospermia: This is the absence of spermatozoa in the semen sample. In 50% of these cases spermatozoa can be collected by puncturing the epidydimis or a testicular biopsy.

3) Disabled men with neurological or medullar disorders; men with ejaculation disorders, such as retrograde ejaculation (the sperm is ejaculated into the bladder and thus the urine must be collected to retrieve the sperm) or anejaculation or absence of semen discharge (which can be treated with certain procedures like electroejaculation, which makes it possible to collect sperm for the ICSI).

4) Fertilization failures in an in vitro fertilization (even when the semen is normal).

5) Unexplained infertility. Frequently, when a patient presents this clinical pattern and the option is a high-tech technique, the specialist may directly choose to use an ICSI procedure in order to secure the formation of embryos and prevent failures in fertilization which are rather often found in unexplained infertility.

ICSI Success Chances

These techniques have a success of 35% per attempt in women under 38. Past this age the chances are significantly reduced.

ICSI Risks

Until today, no increase in malformations or genetic disorders have been observed in patients undergoing ICSI as compared to general population.
The main complications, ovarian hyperstimulation and multiple pregnancy, derive from ovarian stimulation. In general, we perform a significant stimulation in order to obtain a large number of eggs. However, in some very rare occasions, egg production is much higher than the one we are seeking for. This results in a condition known as ovarian hyperstimulation syndrome, consisting of ovarian enlargement with accumulation of fluid in the belly, multiple kinds of discomfort and disorders in the blood test results. This syndrome is generally cured spontaneously.
The second complication, multiple pregnancies, also derives from an excessive stimulation. It is known that twin pregnancies are not considered a complication, for risks for the mother and babies are only slightly increased. However, pregnancies with triplets and more (high-order multiple pregnancies) really imply serious complications both for the pregnant woman and the babies. The delivery will be pre-term and the babies will be premature, with huge risks involved, weeks or months of NICU (Neonatal Intensive Care Unit) and the possibility of permanent problems for the babies. Anyway, although stimulation with the ICSI is significant and all the eggs available in the ovaries are retrieved, only 2-4 embryos are transferred, depending on the woman’s age (2 good quality embryos in the case of women under 38 and 4 in the case of women past this age), and consequently the occurrence of high-order multiple pregnancies with this technique is very unusual.

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