This is a relatively new but well established procedure, first performed in Belgium in 1992. It was developed to help male factor infertility and has succeeded in reducing very considerably, the use of donor sperm in contemporary infertility management.
It involves injecting a single sperm into the cytoplasm of each egg using a fine glass needle. The ability of the sperm to penetrate the egg is no longer an issue as this is done as part of the procedure.
ICSI: An egg being micro-injected with a sperm
It should however be remembered that ICSI though useful to help in achieving fertilization, does not guarantee it, as fertilization is generally unsuccessful with poor quality eggs
It is indicated in:
- Couples who have failed to achieve fertilization or poor fertilization after conventional IVF treatment.
- Men with abnormal sperm parameters.
- Azoospermic men.
- The use of Cryopreserved sperm samples which are limited in number and quality.
The couples go through the same preparatory processes as in conventional IVF, namely ovulation induction and egg collection. The difference arises in the way the eggs and sperm are treated in the laboratory.
Specialized equipments are required for the procedure, these enable our embryologists to manipulate the eggs and sperm under the control of high-powered microscopes, performing very precise delicate surgical manoeuvres at microscopic levels.
Sperm collection can be from ejaculate or aspirate from the epididymis (PESA) or testes (TESA or TESE). Sperm preparation may also be obtained from frozen semen sample or testicular tissues. ICSI does not increase the incidence of multiple pregnancy as compared to conventional IVF.
Safety of ICSI
The major concern about ICSI has always been its safety. This has generated a lot of debate both in the medical and lay press mainly because of the fear of injection of abnormal sperm, since ICSI bypasses the natural stages of sperm maturation and selection.
However current evidence does not show a significant increased risk of congenital abnormalities in children conceived through ICSI. It is however known that some forms of severe male infertility have a genetic link and it is possible that the genetic disorders which have led to the sperm problem in the father may be passed on to the offspring.
We advise that children conceived as a result of ICSI have regular developmental assessment and please keep us informed of the results as this will help in the provision of more accurate information to prospective couples.