What is ICSI?

Intracytoplasmic sperm injection, or ICSI, involves injecting a single live sperm directly into the center of a human egg. The technique was developed to help achieve fertilization for couples with severe male factor infertility or couples who have had  fertilization failure in a previous in vitro fertilization (IVF) attempt. The procedure overcomes many of the barriers to fertilization, and allows couples with little hope of achieving  a successful pregnancy to potentially obtain fertilized embryos.

A cycle of ICSI requires the female partner to undergo controlled ovarian stimulation (COS) so that more than one egg containing follicle develops. These follicles are aspirated using transvaginal ultrasound, and an embryologist will collect the eggs from the follicular fluid. The eggs are incubated in the embryology laboratory under specific conditions, while the semen sample is prepared. The outcome of the semen preparation is to separate the live sperm from the seminal plasma, dead sperm and debris, and this is done by centrifuging the sample through a special medium. Prior to the ICSI procedure, the embryologist will remove the support cells that surround each egg so that the eggs can be seen in more detail. Eggs that have reached the correct stage of maturity will undergo ICSI. This involves the embryologist picking up a single live sperm with a fine glass pipette and injecting it directly into an egg. This is repeated for each mature egg.

Who should consider ICSI?

ICSI is considered absolutely necessary is in the case of male factor infertility cases with indicated by an abnormal semen analysis. In the Bay Area, however, about 75 percent of all IVF cases are now ICSI. However, many pPatients may choose are electing to undergo ICSI for reasons other than male factor infertility to maximize their chance of success, including the following situations: • Previous poor fertilization with IVF • Variable sperm counts • Unexplained infertility Many patients choose to undergo the ICSI procedure in order to maximize their success even when the procedure is not clearly indicated. If you have been told that there are abnormalities with any sperm test results, you should give serious consideration to ICSI. If the male partner has had a vasectomy reversal, we also recommend ICSI regardless of the sperm quality because of the presence of anti-sperm antibodies that may affect fertilization. The decision to proceed with ICSI is particularly difficult if there is no prior evidence of male factor infertility. Some couples choose ICSI because they want to do everything possible to maximize fertilization. However, it is important to understand that for many couples with normal sperm parameters, maximal fertilization can potentially be achieved with standard insemination during IVF without the use of ICSI.
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