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Intracytoplasmic sperm injection (ICSI)

 
INTRACYTOPLASMIC SPERM INJECTION (ICSI)

Male infertility treatment has been revolutionized with the advent of micromanipulation. Till then recourse to medication. Operative procedures like varicocele ligation, vaso-epididymal anastomosis etc and of course IUI, IVF-ET with pooling of semen samples was the only alternative available. This however could not yield desired results especially in cases with severe oligoasthenoteratospermia. Azoospermic cases with no sperm production could not benefit. IVF also could not offer a solution in cases with failed fertilization. 1CS1 was first reported in 1992 by the group from Brussels.

The evolution of ICSI can be traced to attempts at gamete manipulation. PZD- partial zona dissection was first tried out to enhance probability of sperm penetration.24 This was followed by SUZT wherein sperms were injected into the perivitelline space with a micro pipette.25 Subsequently ICSI was tried wherein a single sperm was directly injected into the ooplasm resulting in a healthy livebirth. ICSI proved to be superior to SUZI (subzonal sperm insertion), which gave sperm a head start by injecting them through the outer layer of the egg.

 
ICSI
If there is a question of the sperm's ability to fertilize the egg, due to either a low sperm count or poor quality of the sperm, that poses no problem whatsoever. Intra-Cytoplasmic Sperm Injection (ICSI) would be performed instead of regular In Vitro Fertilization (IVF). With ICSI, the eggs are retrieved the same as if you were doing conventional IVF. However, the eggs and the sperm are then fertilized in the laboratory, by direct injection of a single sperm into each egg. Three days later the resulting embryos are simply placed into your uterus with no surgery, just as with IVF. Extra embryos are frozen for later attempts at pregnancy.
The availability of this Intra-Cytoplasmic Sperm Injection, "ICSI" technique  means that men whose sperm previously were too weak or too few to fertilize in vitro (IVF), now have no problem fertilizing their wife's eggs. The fertilization rate per egg using ICSI is about 70% despite the sperm being terrible, the fertilization rate per infertile couple is over 99% if the wife has adequate eggs, and the pregnancy rate per treatment cycle is over 50%. This is not significantly different from regular IVF with normal sperm. This technique is very cost-effective, and will give you the same high chance for getting pregnant as any couple with normal sperm.
 
Overview
Intracytoplasmic sperm injection, or ICSI, is a micromanipulation technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous in vitro fertilization attempt. The procedure overcomes many of the barriers to fertilization and allows couples with little hope of achieving successful pregnancy to obtain fertilized embryos. The procedure was first used at UCSF in 1994 and the first successful birth, achieved with ICSI assistance, was in February 1995. UCSF was the first San Francisco Bay Area program to achieve a pregnancy and birth with this "miracle" procedure.
 
How ICSI Works
The technique involves very precise maneuvers to pick up a single live sperm and inject it directly into the center of a human egg. The procedure requires that the female partner undergo ovarian stimulation with fertility medications so that several mature eggs develop (IVF). These eggs are then aspirated through the vagina, using vaginal ultrasound, and incubated under precise conditions in the embryology laboratory. The semen sample is prepared by centrifuging (spinning the sperm cells through a special medium). This solution separates live sperm from debris and most of the dead sperm. The micromanipulation specialist picks up the single live sperm in a glass needle and injects it directly into the egg.
Through the ICSI procedure, many couples with difficult male factor infertility problems have achieved pregnancy at UCSF. Fertilization rates of 70-80% (of all eggs injected) are currently being achieved, and pregnancy rates are comparable to those seen with IVF in couples with no male factor infertility.
 
7 Steps of ICSI
Sperm Selection
Sperm Selection
Sperm Stabilization
Sperm Stabilization
Sperm Pick-up
Sperm Pick-up
Penetration of Egg Shell
Penetration of Egg Shell
Penetration of Egg Membrane
Penetration of Egg Membrane
Sperm Injection
Sperm Injection
Needle Withdrawal
Needle Withdrawal
 
 
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