What is ICSI?

Who doesn’t want a child? What is ICSI and Its role in it? In recent times, several instances have been found where the couple is not having their baby. It can be due to either’s health issues that one can’t change overnight. Still, any married couple expects to have a baby. To bring a smile to their faces, medical science has offered various ways. Using those technologies, any childless couple can have a baby. Yes, the process is a bit lengthy, and it is not a guaranteed one. Still, the success rate is very high in such cases, and you can expect a child as per the process. 

What is ICSI? 

What is ICSI treatment and why it is suggested is the usual question couple asks when in need. ICSI or Intracytoplasmic Sperm Injection is a process where you can expect a baby if you are not conceiving in the normal process. It is associated with another popular way of fertilization named IVF (In Vitro Fertilization), although there is a substantial difference between them. In general, ICSI is normally used to fight against severe male infertility cases. But that is not the only purpose of doing so. ICSI is performed as an additional part of the entire IVF treatment cycle. In this process, a single sperm is injected into each egg for assisting fertilization by using micro-manipulation equipment. 

For whom ICSI procedure is Done? 

ICSI treatment is recommended once doctors find a very low sperm count in the case of the male partner. Further, if he has other fertility issues like anti-sperm antibodies or low sperm morphology, ICSI is also used to overcome such odd situations. It is also used in those cases where vasectomy happened earlier, or there was an unsuccessful attempt of vasectomy reversal. Apart from this, ICSI is equally useful in case of no fertilization happened in the IVF process. 

Details of ICSI

ICSI stands for Intracytoplasmic Sperm Injection, a special way of fertility in the human body. Before entering into the details, let’s check how fertilization happens normally. In the process of fertilization involving a man’s sperm and a woman’s egg, the head of the sperm should be attached to the outside of the egg. After this attachment, the sperm can push through the egg’s outer layer to enter inside. Once the sperm enters into the cytoplasm (inside of the egg), then fertilization takes place. 

In some cases, the sperm becomes unable to penetrate the egg. This can happen due to various reasons. The egg’s outer layer might be hard or thick that makes the sperm unable to enter into that. Here comes the process of ICSI or Intracytoplasmic Sperm Injection, where a single sperm is injected directly inside the cytoplasm of the egg. As a result, fertilization happens. 

ICSI Procedure Step by Step

There are two ways to complete the steps in the IVF process – one is the traditional one, and the other is using the ICSI procedure. In the case of traditional one, thousands (in fact in lakhs) of sperms are placed next to the eggs in the laboratory. In a general way, fertilization happens when one sperm is used to enter into the egg’s cytoplasm. If, for any reason, it doesn’t happen, then ICSI comes into the rescue operation. A tiny needle named a micropipette is used to inject a single sperm into the egg. This is the way of fertilization in the ICSI process, and the embryo grows in the laboratory for some days before it is implanted in the womb of the female partner. 

Why is ICSI done? 

There are a couple of strong reasons in favor of executing the ICSI procedure. Here are those: 

• If eggs are not fertilized by the IVF process regardless of whatever the condition of the sperm
• If frozen eggs or in vitro matured eggs have been used previously without success  
• If you find any blockage in the male organ for delivering sperm
• If the sperm is not moving in the normal fashion or the sperm is finding difficulty in being attached to an egg
• If too little sperm is produced that is not adequate for fertilization

ICSI Procedure & Male Infertility

ICSI is used in most cases where the male partner-facing fertility issues. This is known as male factor infertility, and it is increasing every day due to multiple reasons. There might be a lower sperm count that can fertilize an egg, or the sperm cannot enter into the eggs strongly. Sometimes, although testicles are producing sperms, they are not ejaculated either due to any abnormality or blockage in the path. In such cases, sperms are extracted from testicles and used for fertilization with eggs using the IVF and ICSI processes. This process is very helpful in cases where any previous IVF process failed to produce any fertile result. 

ICSI Success Rate

Generally, this process can fertilize 50-80% of eggs subject to conditions. The success rate is higher than any other, and one can be assured of perfect fertilization within a given period. Once the fertilization happens, then you can easily expect your baby unless any major complications arrive all of a sudden. Still, a few issues may arise like: 

• Either all or some of the eggs may be damaged.
• Even after injection, the egg might not grow into the embryo
• Embryo might stop growing all of a sudden

The chance of birth defects in ICSI is less compared to normal or even IVF process. But if critical conditions are noticed in the entire process, then there might be some issues. Some critical conditions like Angelman syndrome, sex chromosome abnormalities, hypospadias, or Beckwith-Wiedemann syndrome might be noticed in the process, but it is hardly 1% of the entire operation. 

How to Improve the ICSI Result?

There are a couple of options through which we can improve the success rate of ICSI. Here are those: 

• You have to choose the sperms with good DNA fragmentation index
• In the case of poor motility, need to have double ejaculation
• Embryologists must select the good sperms and proper ICSI technique
• Usage of optimal stimulation protocol to provide bests eggs to the practitioner
• Application of best available preparation technique to get accurate pregnancy result

IMSI & Congenital Malformations 

IMSI or intracytoplasmic Morphologically process is also associated with ICSI where the sperms are generally chosen under 6000 times magnification for producing better quality embryos. Chances of pregnancy increase in this method, and this process are still under evaluation method to be finally acknowledged. 

In the case of congenital malformation, it is applicable for both natural conceptions and ICSI. That is why genetic screening is very important, and it should be conducted to find whether any issue is there or not. 

How Safe is ICSI? 

ICSI is relatively a safer option for people. To date, no such adverse effect has been reported unless there were some genuine genetical problems. Although it is in the hands of the clinical expert to clean the eggs and inject the sperm inside them delicately. Else those can be damaged. 

In terms of genetic developments, you can have genetic testing initially to find out the details. If the report is good, then you need not worry. If the genetic report shows some abnormalities, you can give a second thought to having a baby. 

Pros and Cons of ICSI

The pros and cons vary on the physical condition of the couples. But in most cases, pros are on the higher side than cons. 

Pros: 

When the male partner has inadequate sperm or less mobility of sperm, then still couple can expect a baby through the ICSI process. 

The entire process is very smooth, and one can experience a painless operation throughout the journey. 

This is also a cost-effective solution as other methods are costlier. 

Cons:

There is a lack of expert ICSI practitioners who can perform this in every corner of the world. If you want to do this treatment, you have to travel to the nearest big city to avail such. 

The success rate also differs due to the actual condition of the couple

What is the difference between ICSI and IVF? 

IVF, also known as In-vitro fertilization is the process in which the fertilization takes place outside the body in an IVF lab. The sperm and egg are fertilized inside an IVF lab. The then-formed embryo is transferred back to the uterus to implant. Whereas ICSI is one step ahead of IVF, where the sperm is injected inside the cytoplasm of the egg, to further enhance the chances of pregnancy.

Some clinical experts believe that this procedure is mandatory for every IVF cycle. On the other hand, some think that ICSI must be reserved for extreme male infertility cases. In most cases, due to low sperm count, abnormally shaped sperm, and poor sperm movement, ICSI is recommended. 

Apart from this Difference between IVF and ICSI, there are extreme situations where IVF & ICSI are linked very closely. For example: 

Previous IVF Cycle with No Result – It happens that despite a good number of eggs are retrieved, and the sperm count was also perfect. Still, no fertilization took place. In such conditions, in the next IVF cycle, ICSI can try to get a fruitful result. 

Conclusion

So, if you are fighting sperm-related issues, then ICSI is the best option for you. Be it a smaller number of sperm or if the sperm cannot swim into the eggs, It offers you the most comprehensive solution of fertilization. Paired with IVF, ICSI becomes the best combination for childless people. As the success rate is quite high, you can expect to have a baby in this process. 

FAQs

How long does ICSI treatment take? 

Generally, one cycle of ICSI treatment usually takes four to six weeks to complete the entire process. It varies due to sperm and egg retrieval time from male and female partners, respectively. 

Are ICSI Babies Normal? 

Babies born using either IVF or ICSI process are not at all different from the babies conceived naturally. They don’t have any health problems and no such illness during or after birth. 

Can You Have a Twin with ICSI? 

As sperm is injected into the egg, especially to conceive, then twin pregnancy might have a serious effect on the mother’s health. The fertilization process may hamper. 

How is sperm chosen for ICSI? 

Sperm are chosen basically by checking the shape (morphology) and forward movement (progression). Then the best one is picked in the needle. Once sperm is in the needle, it is dropped into the eggs. 

Are 6 Eggs good for ICSI? 

More eggs encourage the option to have higher fertilization chances. IVF triggers that. It is ideal to have more than ten eggs to get the best result. More than six eggs are also good, and ICSI has been able to work with even 3-6 eggs in the course of fertilization. 

References

https://www.ucsfhealth.org/education/faq-intracytoplasmic-sperm-injection

https://www.novaivffertility.com/fertility-help/
https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets
https://www.completefertility.co.uk/blog-resources/blog-news