ICSI

What is intra-cytoplasmic sperm injection (ICSI) and how does it work?

Intracytoplasmic sperm injection, or ICSI, is a highly targeted fertility approach that involves injecting a single, live sperm directly into the centre of a female’s egg. This procedure was developed to achieve fertilization for couples who have severe male factor infertility or for couples who have failed previously IVF attempts.

This unique procedure overcomes many fertility barriers couples may be experiencing and gives couples with little hope of becoming pregnancy the chance to have a family.  

 

What does the procedure involve?

The procedure requires that the female partner takes fertility medication prior to the procedure in order to stimulate the maturation of her eggs. The specialist will then enter the women’s uterus using an ultra-sound guided catheter to retrieve the eggs from the female’s ovaries. The retrieved eggs are then incubated under very precise conditions in the embryology laboratory so they can develop.

The male partner provides a sperm sample on the day of the procedure. The sperm is isolated from the male’s semen in the laboratory and the live sperm is isolated from the dead sperm.

The embryologist uses a glass needle to pick up the most suitable, healthiest sperm for transfer. This single sperm is then injected into the egg. This method is direct and precise and great option to induce fertilization but it is not guaranteed to succeed. 

If fertilization does occur in the petri dish, the embryos will be cultured in the laboratory for up to six days and approximately between one to five of the best-quality embryos will be selected for transfer to the female’s uterus.

All remaining, good quality embryos that are not transferred will be frozen and stored. These frozen eggs can be used later on at the discretion of the couple for future use. Bedaya Hospital has a very high pregnancy rate for frozen embryo transfers. The advantage of freezing good quality eggs at this point is that it offers a very high chance of the women getting pregnant in a subsequent cycle without having to go through the whole IVF procedure again.

 

Who should consider ICSI?

ICSI is considered absolutely necessary in male infertility cases that involve an abnormal semen analysis. Such abnormalities in semen analysis can include a low sperm count, low or no motility (low or no movement) or aberrant morphology (abnormal shaped sperm). However at Bedaya 90% of all IVF cases are now conducted with ICSI. Patients also choose to undergo ICSI for reasons other than male infertility, these reasons include:

  • Previous attempt at IVF with failed fertilization
  • Sperm counts that are variable
  • Some males require sperm to be collected surgically from the testes or epididymis (a narrow tube inside the scrotum, where sperm are stored and matured) due to a previous vasectomy which prevents males from being able to ejaculate sperm or they have an extremely low sperm production. 
  • Couples are using frozen sperm in their treatment process which is not of optimum quality
  • The couple is using embryo testing (PGD or PGS) therefore ICSI is required
  • There is an unexplained infertility issue
  • Many patients simply choose to undergo the ICSI procedure in order to maximize their chances of success even when the procedure is not clearly indicated.

 

How successful is ICSI?

ICSI has proved successful for many patients at Bedaya. We have been achieving a success rate for fertilization of approximately 70-80% in all eggs that are injected with sperm. Our pregnancy rates achieved are amongst the highest in Egypt and the Middle East.

For ICSI procedures the most challenging step and the step that determines the success for the procedure is the fertilization between the egg and the sperm. This success of the fertilization is determined by many factors such as handling of the samples and maintenance of the samples in the laboratory. The fertilization rate in Bedaya Hospital is exceptional, with approximately an 80-85% fertilization rate and, on average, 8 out of every 10 eggs will successfully fertilize.

 

Are there differences in embryo quality or pregnancy rates between ICSI and non-ICSI embryos?

There appears to be no difference in the overall embryo quality achieved with ICSI embryos compared to non-ICSI embryos. Additionally, no difference in pregnancy rates has been shown between ICSI embryos and non-ICSI embryos.

ICSI