ICSI Treatment in India

Welcome to Bloom IVF

Are you trying to conceive but fail due to male factor infertility problems? The solution is ICSI– A time tried and tested solution for infertile males to become biological fathers. If you’re dealing with infertility issues then read on this helpful article.

Dr. Hrishikesh Pai is among the top gynecologists in India. In 1995, he started with Intracytoplasmic Sperm Injection reproductive technology – ICSI and was amongst one of the first in India.

Since then, he has successfully performed numerous ICSI procedures and fulfilled the dream of couples to become parents. Dr. Pai provides advanced ICSI treatment at an affordable cost.

What is ICSI?

Intracytoplasmic Sperm Injection (ICSI) is a technique in assisted reproduction that involves injecting a single sperm cell into a mature egg. ICSI is an advanced form of In Vitro Fertilisation (IVF) utilized to overcome male-factor infertility.

Process of Intracytoplasmic Sperm Injection (ICSI)

Usually, we perform Intracytoplasmic sperm injection when there are issues with sperm or patients with previous fertilization problems or who need the surgical removal of sperm from the testes.

Steps involved in the ICSI process are:

Step 1: Sperm collection and preparation

In ICSI, we retrieve sperms from the collected semen sample or through Testicular Epididymal Sperm Aspiration (TESA) procedure. It involves direct insertion of the needle in the testicle, and the sperms are then aspirated. Further, the aspirated sperms are more diluted for easy selection.

Step 2: Sperm selection

The IVF process utilizes around 100,000 good quality sperms and combines them with the eggs. In the ICSI procedure, the scientists select a single motile normal-looking sperm with good DNA integrity combined with an egg.

Step 3: Egg retrieval and preparation

After controlled ovarian stimulation, egg retrieval is performed using transvaginal ultrasound guidance. A needle is placed through the vagina into the ovary then into the egg follicle to collect the eggs under suction.

The embryologist examines the eggs under the microscope and further treats them with an enzyme to remove the cells from its surface for easy assessment of maturity. It is the process of denudation. Only genetically mature eggs are utilized in ICSI.

Step 4: Sperm injection

The embryologist collects a single sperm cell into a fine glass tube known as an injection pipette. Then, injects the sperm into the egg. The sperm cell is always collected from the tail first to ensure that it is the head that enters the egg first.

A small suction is applied until there is a slight break of the membrane, then the sperm is injected into the egg; after removing the needle, the egg releases from the holding pipette.

Now, the sperm microinjects into the egg. Thus, giving the sperm a helping hand in penetrating the egg.

Approximately after 40 to 72 hours, the egg is continuously checked for fertilization signs under the microscope. Sometimes as with natural selection, some eggs may not fertilize.

Step 5: Embryo Transfer

Once the sperm microinjects into the egg, the process of fertilization takes place. The fertilized egg develops into an embryo. If the embryo is mature enough, then within 3-5 days, we transfer it to the uterus; in some cases, we have to wait for six days.

Embryos reach the blastocyst stage on the fifth day. At this stage, the embryos are capable of attaching to the uterus.

When the embryo develops into a large cluster of six to eight cells, it is ready for transfer under an expert’s supervision.

After two weeks of the embryo transfer, the would-be mother has to perform a pregnancy test at home using a urinary pregnancy test and inform their doctor about the test result. The test result will determine the future course of IVF treatment.

When is ICSI performed?

Mostly we perform ICSI procedure to overcome the extreme male factor infertility conditions like:

Oligospermia

The state in which the sperm count reduces due to various reasons is called oligospermia. A decrease in sperm count can reduce the chances of becoming a biological father. ICSI is mostly preferred in this condition when infertility persists even after trying various alternate reproduction methods.

Despite other treatment options, if infertility persists, reproductive assistance like ICSI is mostly utilized to achieve conception.

Teratozoospermia

The abnormal shape of the sperm caused due to defects in the sperm head, midpiece, or tail is called teratozoospermia. Abnormal sperm morphology affects natural conception. Thus ICSI method is generally applied to achieve pregnancy. After the egg fertilization, the irregular sperm shape probably doesn’t influence blastocyst development or morphology.

Asthenozoospermia

The term asthenozoospermia refers to reduced or low sperm motility. This condition occurs from metabolic deficiencies or other ultrastructural abnormalities. It is one of the major causes of infertility in men, decreasing the chances of conception. Here, ICSI may increase the likelihood of pregnancy.

Other reasons for the use of ICSI are:

The use of frozen sperm in the previous cycle and the sperm seem to be inactive.
The egg fails to fertilize, despite healthy egg and sperm.
The use of frozen oocytes may harden the eggshells. Then ICSI is also preferred in such cases.
In ICSI, females with a smaller number of eggs undergo ovarian stimulation to produce more eggs.
When embryos need to be analyzed for gene defects by preimplantation genetic testing, ICSI is the only insemination method to avoid polyspermy.
ICSI is the preferred method of insemination by HIV –discordant couples because it avoids the interaction of oocytes with semen, thereby reducing the risk of viral exposure.

What are the advantages of ICSI?

Low sperm count is not an issue in ICSI. The process involves using special instruments and a high magnification microscope to help the embryologist select good-quality sperm.

Experts recommend ICSI for male infertility issues like,

Low sperm counts
Poor sperm motility
Poor sperm quality
When sperm lacks in the ability to penetrate
ICSI is a good option for a person who has undergone a vasectomy.

What are the disadvantages of ICSI?

The chance of birth defects associated with ICSI is similar to IVF but slightly higher than natural conception. This slightly higher risk may actually be due to the cause of infertility and not the treatments used to overcome infertility.
A low sperm count caused by genetic problems could be passed on to a male child, so genetic tests can be done before going ahead with ICSI.

What is the success rate of ICSI?

The success rate of ICSI by the fertilization rate achieved is around 80%-85%. Through ICSI, couples with male factor infertility have achieved 70% to 80% of fertilization rate for all microinjected eggs. This rate is almost equivalent to fertilization with normal sperm. The pregnancy rates accomplished with ICSI are comparable with those achieved through IVF in couples without male factor infertility.