IVF Centre Dehradun, Uttarakhand, INDIA

ICSI (Intracytoplasmic sperm injection)

INTRODUCTION

Intracytoplasmic sperm injection and assisted hatching has revolutionized infertility management especially for males with very low sperm count (less than 1 million per ml), in obstructive azoospermia (no sperm in semen analysis but spermatozoa in epididymis or testis. ICSI procedure entails the deposition of single spermatozoa directly in to the cytoplasm of oocytes. This achieves higher fertilization and pregnancy rate regardless of sperm characteristics.It is generally indicated with very low sperm count and motility, abnormal sperm morphology and repeated IVF failure.

INDICATIONS OF ICSI



NORMAL SPERM PARAMETERS

1. Presence of antisperm antibodies
2. Repeated fertlization failure
3. Cryopreserved sperm


ABNORMAL SPERM PARAMETERS

1. Oligoasthenoteratozoospermia(OAT)
2. Globozoospermia
3. Necrozoospermia
4. Immotile cilia syndrome

EPIDIDYMAL SPERM

1. Congenital absence of vas deferens
2. Acquired vasal block
3. Failed vasoepididymal anastomosis
4. Ejaculatory duct obstruction

TESTICULAR SPERM

1. Failure to retreive sperm from epididymis
2. Testicular failure
3. A- Maturation arrest
4. B- Germ cell aplasia

EJACULATORY DISORDERS

1. Anejaculation
2. Retrograde ejaculation

FEMALE FACTOR INFERTILITY

1. Low number of oocytes
2. Oocyte abnormality (Like thick zona)
3. Repeated failure of fertilization following I.V.F

ICSI PROCEDURE

1. Drug treatment, to stimulate several eggs to mature
2. GnRH agonists to suppress all other hormone activity (injections/ nasal spray for (usually) 2 weeks before gonadotropins and next 10-14 days depending on response)
3. Gonadotropins to stimulate the growth of follicles and cause ovulation
4. Monitoring of treatment, to measure the growth of follicles, individualize drug doses, and prevent serious side effects
5. By TVS Scanning (2 or 3 times during by measuring hormones in blood sample)
6. Egg collection, usually under anaesthecia last 10-20 minutes
7. Guided by TVS
8. Collected through the vagina (32-36 hrs. after final hormone injection)
9. Sperm sample, provided on the same day as egg collection 10. Fertilization
11. One single sperm cell is injected into a single egg cell
12. Eggs are examined next day to check fertilization
13. Embryo transfer
14. Pregnancy testing/monitoring