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INTRACYTOPLASMIC SPERM INJECTION (ICSI)

Treatment & Procedure

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm cell is injected directly into the cytoplasm of an egg by using a glass needle mounted on a micro-manipulator. Very few sperm are required and the ability of the sperm to penetrate the egg is no longer important as this has been assisted by the ICSI technique. With either traditional IVF or ICSI, once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 1 to 5 days before it is transferred to the woman’s uterus (womb).

When is ICSI Done:

  • The sperm count is very low
  • The sperm cannot move properly or are in other ways abnormal
  • The Sperm has been retrieved surgically from the epididymis (MESA/PESA) or the testes
  • (TESE/TESA), from urine or following electro-ejaculation
  • There are high levels of antibodies in the semen
  • There has been a previous fertilisation failure using conventional IVF 

Steps of ICSI

Ovarian stimulation is used to mature multiple eggs for egg retrieval. Even if ovulation is normal, fertility drugs are used to produce more than a single egg because are higher with more eggs. Most women will take drugs for ovarian stimulation for 8-14 days; the average is 10-11 days. Fertility drugs for IVF are usually injected, and you’ll be frequently monitored using vaginal ultrasounds for the best result. Once an ultrasound determines whether you have a sufficient number of large enough follicles, you’ll receive a trigger shot of hCG or other medication
Thirty-four to thirty-six hours after receiving the trigger shot (hCG) – before the eggs ovulate – you’ll have a surgical procedure to remove the eggs from the follicles in your ovaries. For this egg retrieval procedure, an ultrasound is used to visually guide a small needle through the vagina into one ovary and then the other. The fluid from the follicles – that contains the egg – is suctioned by the IVF physician through small tubing and into a test tube. The test tube is then handed to an embryologist who uses a microscope to find the egg in each test tube of follicular fluid. In case there are no eggs retrieved in the fluid then donor eggs can be used.

Once eggs reach the lab, experts examine them to determine maturity and quality. Mature eggs are transferred into a special culture medium, placed in an incubator and within a few hours of egg retrieval are fertilized with sperm using micro-manipulator by an embryologist. In ICSI a single sperm is picked up with a fine glass needle and is injected directly into each egg.

If the sperm fertilises the egg, it becomes an embryo. Fertilization is assessed 16 – 18 hours after insemination or ICSI. The fertilized eggs are called zygotes and are cultured in a specially formulated culture medium in incubators that supports their growth. The conditions for embryo development are made similar to uterus. They will be assessed on the second and third day after retrieval. Following this would be selection of embryo for transfer. 

Embryos are transferred on day 3 when they are at the cleavage stage (6 – 8 cells) or on day 5 when they have reached the blastocyst stage. Embryo transfer is a simple procedure that does not require any anesthesia. An embryologist prepares your embryo by placing it in a small tube called a catheter. It’s critical this is done by an expert to disturb the embryo as little as possible. Embryos are loaded in a soft catheter and are placed in the uterine cavity through the cervix. 

Approximately 15 days after your embryo transfer, you’ll have a blood test to measure your levels of the hormone hCG. hCG in your bloodstream usually means a positive pregnancy test. If the pregnancy is confirmed positive by blood test then you will be called upon for a followup visit after approx. 20 days for first USG. In USG the yolk sac in which the embryo has started developing shall be seen and you can even hear the heartbeat of your baby !

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