ICSI (Intra Cytoplasmic Sperm Injection)

 

Male Infertility

Misconceptions are very common in the world of infertility. One popular myth is that infertility is the woman's problem and that once that "problem" is fixed, the couple will be able to conceive. This could not be farther from the truth. In fact, in nearly 30% of all infertility cases, the cause is attributed to a factor in the male and in an additional 30% of cases the cause is attributed to both male and female factors. Less than a decade ago, treatment for a severe male factor was limited to inseminations or IVF using donor sperm. Today, exciting advances in male infertility have introduced innovative therapeutic options that offer men, including those with no sperm in their ejaculate due to genetic conditions, a greatly improved chance to conceive their own biological offspring.

This is the process of picking up a single sperm in a fine needle and injecting it directly into the cytoplasm (body) of the egg to aid the process of fertilization.

 

Treatment

The procedure is the same as for an IVF treatment cycle. Ovaries are   stimulated with fertility drugs so as to obtain as many eggs as possible and the egg recovery usually takes place 10 to 12 days after the drug has been started.

 

Procedure

On the day of egg recovery, the male partner will need to provide a semen sample.  About  six hours after the egg recovery, the embryologist will carry out the ICSI procedure by selecting sperm for injection (one that is motile and with normal appearance).

The egg is held in place with a fine tube, and an ultra-fine needle is passed through its shell and brought into contact with the egg's membrane. The needle is then carefully pushed through the membrane into the centre of the egg, and the sperm injected with the minimum amount of fluid. The needle is carefully withdrawn, taking care to leave the sperm within the egg. The same procedure is then carried out to try to fertilize the remainder of the eggs.

 

Advantages of ICSI over IVF

ICSI can be performed for men who have very few numbers of sperm in their semen, too few for IVF.

• It can be performed for those men whose sperm have minimal activity which would be too slow for IVF
• There is usually a higher fertilisation rate, therefore, couples have a higher number of embryos to transfer, than would be the case with IVF
• There can be a reduction in the number of eggs fertilised by more than one sperm.
• There is the option of using the male partner's sperm instead of donor sperm.

 

Indications for ICSI

• Those patients for whom IVF has not succeeded due to poor or no fertilization of eggs.
• Men whose semen contains very low numbers of sperm  which are sluggish, and with poor motility where enough active sperm are not available for IVF.
• Men who have an obstruction of the vas deferens (the tube that leads from the testicle to the base of the penis). The vas may be obstructed by infection, or previous vasectomy, or in some cases, men are born without a vas. Sperm can he surgically removed from the epididymis (the area on top of the testes where sperm are maturing), or directly from the testicle.
  

Although sperm can be obtained from these areas, numbers are usually very low and may exhibit poor motility, therefore ICSI is used to increase the possibility of fertilizing an egg.

Obstructive azoospermia may be corrected surgically, or sperm recovery techniques such as TESE (testicular sperm extraction)(Figure 11) or MESA (microsurgical epididymal sperm aspiration)(Figure12) may be used.

 

Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is indicated for men with irreparable obstruction resulting in azoospermia (lack of or no sperm), congenital absence of the vas deferens or failed vasectomy reversal. The procedure takes approximately 10 to 20 Minutes and does not require a surgical incision-a small needle is passed dirctly into the head of the spididymis and fluid is aspirated. Subsequently, the IVF labortory team retrieves the sperm cells from the fluid and prepares them for ICSI because of the limited amount secured. The Fertility Centre team in New England was the first to offer PESA.

 

Testicular Epidydinal Sperm Aspiration (TESA)

Surgical removal of a portion of the testicular tissue for patients who are not good candidates for PESA. In the andrology laboratory, tissue is homogenized (minced) and individual sperm is collected for ICSI.