Intra Cytoplasmic Sperm Injection
The word “ICSI” (ICSI) is derived from the reduction of the first letters of the English phrase Intra Cytoplasmic Sperm Injection and literally means “the introduction of sperm into the oocyte cytoplasm.” This procedure is performed usually in the cases of severe forms of male infertility in which the fertilizing capacity of sperm is significantly reduced.
- Indications for ICSI method are the following:
- azoospermia – no sperm in the ejaculate;
- Oligozoospermia – reduced sperm concentration of less than 2 million/ ml;
- Asthenozoospermia – less than 1million active moving sperm 1ml of ejaculate;
- Teratozoospermia – less than 5% of normal structured sperm;
- Combined pathology of sperm (possible different combinations of changing in the concentration, moving activity and structure of spermatozoids, which significantly reduces a semen’s fertilizing capacity more than other kinds of dysfunctions in isolated state).
- The presence of antispermatozoal antibodies (MAR-test more 50%) in ejaculate, which is an obstacle for natural fertilization even in the cases of the normal concentration of spermatozoids
- An absence or unsatisfactory results of an ovum fertilization in a previous attempt of in vitro
- Woman’s age is no more than 38 years old.
Technique of the ICSI
ICSI is performed on the day of receiving eggs from the woman or the next day, if self-fertilization does not occur. Before the ICSI, the cells of radiate crown surrounding the egg are removed. Micromanipulations are performed only in mature oocytes in the presence of the first polar body. Receiving the sperm for ICSI can be done from the ejaculate or by surgical methods. With the help of micro-instruments under a microscope, we select sperm of good quality. It is placed in the micro-needle, with the help of which we do the injection into the pellucid zone of the egg, and then sperm is injected into the cytoplasm of the oocyte. Thus, fertilization is carried out on all received injected eggs.
Injection of spermatozoids into the egg:
- Micro-needle with spermatozoid
- Polar body of the egg
- Fixing pipette
Results of ICSI
Frequency of fertilization with ICSI can vary from 30 to 80%. There is no guarantee that each egg after the procedure will be embryonate. Failure to fertilize the egg and division may be related to the difficulty of the procedure (egg damage), as well as the quality of the gametes. For example, when selecting sperm for ICSI, they can be of good quality (motility and structure) but can contain chromosomal abnormalities. The quality of eggs also impacts on the results of the ICSI and the entire program in vitro. In general, the pregnancy rate after ICSI does not differ from that on the average during the classic program of in vitro and it is 40-45%.