ICSI (Intra-Cytoplasmic Sperm Injection)

For many years, infertile men had no way of fathering their own children. Oftentimes, feelings of shame and hopelessness accompanied men with any of the following sperm issues: 1) low or no sperm count, 2) sperm with poor motility or progression, 3) sperm with abnormal head/tail morphology, or 4) the inability of sperm to penetrate an egg in order for successful fertilization to take place.

Today there's hope for infertile men. Intra-Cytoplasmic Sperm Injection (or ICSI) is a well-established and highly-effective procedure to help infertile men father their own children. Here's how it basically works: ICSI is the process whereby a single sperm is selected and injected into your partner's egg. The process uses sophisticated micromanipulation instruments and tools. This procedure has revolutionized male factor infertility treatment since being implemented in the late 1990's. ICSI is so effective, it can provide a man who previously had a 0% chance of fertilization with a normal, 80% or greater fertilization rate! Keep reading to learn more.

Gives hope to infertile fathers who want to father their own children
Injects sperm directly into a female egg for fertilization
No need for a sperm donor
Has over an 80% success rate for infertile men
Works even if male sperm is of poorer quality
Only needs a single sperm for fertilization

ICSI and the Medical Establishment

Like most new procedures, ICSI was met with it's share of skepticism. Certain detractors in the medical establishment had their concerns. Some believed bypassing the normal fertilization process might increase the number of abnormal children. It was logical to suspect that an abnormal sperm might create an abnormal baby. However, with years of studies and the first ICSI children now in their teens, we can safely say that ICSI does not increase the risk of abnormalities in children conceived using this procedure. What we can't say yet is whether or not certain abnormal sperm traits of ICSI patients are being passed on to male offspring. We'll need years of studies of reproductive age ICSI offspring to determine this for sure, but even if a link does prove to exist, ICSI can be used to treat future generations just as well.

Think of each sperm as a delivery truck, delivering DNA instead of cargo. Although the sperm or truck may be a lemon, it doesn't mean the DNA or cargo it's carrying is in any worse condition than that being transported in a nice, clean, well-tuned vehicle. Despite the poorest quality sperm in some men, their DNA isn't necessarily compromised. The sperm itself is just a means to transport the really important stuff, and once delivered to its proper destination, can unload its perfectly intact genetic material. We know this, because our fertilization rates are over 80% in men with abnormal sperm. The results speak for themselves. If you're an infertile man, check out ICSI today.

Indications for ICSI

Besides the male partner having abnormal sperm, when else should you consider ICSI treatment? Below are some other indications to discuss with your doctor in which ICSI may be beneficial. ICSI may be indicated for past failed fertilization procedures. A lack of fertilization may sometimes occur during an In-Vitro Fertilization (IVF) procedure even though the sperm and eggs appeared and tested entirely normal. This could suggest individual sperm and/or egg abnormalities that are preventing successful interaction of the gametes.

ICSI Process and Eggs

ICSI is a highly technical process performed by an Embryologist. It requires many hours of preparation, skill and dexterity and should only be performed by an embryologist with years of training in order to achieve optimal fertilization rates. Remember, ICSI has over an 80% fertilization rate with even poor quality sperm.

The human egg is about the size of a grain of sand. Your sperm is thousands of times smaller. Your Embryologist must have excellent hand-eye coordination and high-tech equipment to perform ICSI. Our Embryologists are so confident in their ICSI skills that they video record the process in order to view and discuss it with the patients following embryo transfer. Couples seem to really appreciate this aspect of treatment - not just taking our word for how the process worked but to actually see it performed on their very own gametes. It certainly seems to bolster their hope and confidence in having a child.

ICSI and Egg Maturity

Sperm from the male partner doesn't have to be of terrribly high quality for the ICSI process to work well, but the eggs produced by the female must be mature as only mature eggs are capable or normal fertilization. Conventional IVF doesn't necessitate us knowing egg maturity since, in the presence of many sperm, mature or maturing eggs will accept sperm when they are ready. With ICSI cases, however, sperm are generally not capable of penetration on their own even when the eggs are ready, so we must confirm which eggs are mature before mechanically introducing sperm into them.

So clearly, recovering mature eggs is vital to a successful ICSI procedure. To increase your chances of success, we'll closely monitor your ovarian stimulation cycle to make sure you are developing appropriately-sized and timely follicles (follicles are small cyst-like structures that form on your ovaries during your cycle and hopefully contain eggs). Keep in mind that not all of your follicles will contain mature eggs, some will have immature eggs, some will have no eggs. Our goal is always to help you stimulate and produce as many mature eggs as possible, ideally between 8 to 12. Also, some women's ovaries may be over-responsive to ovarian stimulation capable of producing more than 20 eggs in a given cycle and some under-responsive producing as few as one or none. Your GYFT physician will tailor your stimulation to suit your response so we get the optimal outcome.

ICSI and Assessing Egg Maturity

When preparing for ICSI, we assess the maturity of your eggs 2-3 hours after retrieval. An Embryologist places the egg and cell complex in a solution containing a natural spermatic enzyme called hyaluronidase. This substance helps dissolve the cell complexes that surround your eggs. A fine pipette is used to gently remove the entirety of these cell and, once completed, we can ascertain the maturity of your egg.

Egg maturity is confirmed by seeing the "polar body." It resides between the cytoplasm of the egg and the inner membrane of the egg's shell. The inner membrane is called the "zona pellucida". If your egg shows a polar body, it will be used for ICSI. Eggs without a polar body will be returned to the culture environment and checked on periodically during the day for polar body formation. Again, if a polar body appears, that egg can be used for ICSI.

ICSI Procedure

Once mature eggs have been identified and chosen, they're placed in a biological incubator designed to simulate the temperature, pH and humidity of your reproductive tract. As the eggs equilibrate with the in vitro environment, the ICSI equipment is prepared. The ICSI procedure is done using a micromanipulator which is a specialized piece of microscopic equipment. The micromanipulator is encased inside an incubated acrylic enclosure in which special micro-tools are mounted. The micro-tools are controlled by the embryologist from outside the incubated enclosure use fine-tuned "joysticks". The microscope is also attached to a video camera in order to record the procedure.

The micro-tools include the holding pipette and the ICSI needle. The holding pipette holds the egg in place while performing the sperm injection. The ICSI pipette is a delicate needle, just wide enough to allow one sperm to enter. This pipette orients the sperm to enter the egg from the opposite side of the holding pipette. For the best fertilization results, ICSI must be done as quickly and efficiently as possible. To facilitate this, several mature eggs are placed in tiny media droplets around the periphery of a Petri dish. A drop of sperm is placed in the center of this dish. The sperm and egg drops are kept separate and covered using a layer of sterile, warm paraffin oil. The oil acts as a protective barrier for the gametes while being manipulated.

The microscope is fixed to ~400x magnification. The ICSI needle is lowered into the sperm droplet where a single sperm is selected, immobilized and picked up with a delicately controlled suction device. The ICSI pipette is raised from the sperm droplet and lowered, along with the holding pipette, into a micro-drop containing an egg. Using a small amount of suction, the egg is drawn to the holding pipette and held in place as the ICSI needle containing the single sperm is brought toward the egg.

The sperm is brought toward the tip of the ICSI needle. The needle pushes the sperm against and through the zona and into the oolemma of the egg. A small amount of ooplasm is aspirated into the needle to verify complete penetration of the membrane. This ooplasm is then quickly injected back into the egg proper along with the sperm. The needle is carefully withdrawn and the suction is released from the holding pipette to release the egg.

We repeat the process for each mature egg. The time from sperm selection to sperm injection should take less than 2 minutes per egg! Once the procedure is done, we transfer the eggs to a biological growth medium in the primary culture environment. They will be checked for fertilization the following morning, typically 18-20 hours later. From this point on, the culture and development processes will be the same as those used in a conventional IVF cycle. These include steps from fertilization checks to embryo development and transfer.

Notes about ICSI

Using ICSI provides successful fertilization for almost all couples. However, not all of the eggs used in the ICSI process will necessarily fertilize and some, albeit very few, won't survive the injection process. And although we can guarantee one sperm has been placed inside an egg, we can't guarantee that the sperm or egg will always work like they should to successfully fertilize, develop on time, or produce high quality embryos. Here are some reasons your success may be affected.

If the oolemma of certain eggs have the physical characteristic of being too fragile, sperm injection occurs with minimal resistance and penetrated too easily with the ICSI needle. This often results in ooplasm leaking out through the needle's entrance and the egg quickly degenerates. Fortunately, this happens to fewer than 5% of eggs.

Conversely, highly elastic eggs can be hard to penetrate with the needle. Damage can ocur to eggs that distend too much before allowing the ICSI needle to penetrate. Also, sometimes these eggs have thick, clumpy ooplasm that can impede the dissolution of the sperm into the egg proper.

Ultimately, the quality of the eggs often dictates the ease and subsequent success of the ICSI process. Because not every egg can be a good one, your GYFT phycisian will guide your stimulation so we can make sure we have numerous mature eggs to work with. Having a good number of mature eggs allows for some of the eggs to be of poorer quality while still maintaining a high likelihood of success with the remaining good quality eggs. Again, we expect a fertilization rate of 80% or better using ICSI.

Contact the Gyft Clinic for affordable fertility and gynecology services. Schedule an appointment at 253-777-1964.