What is ICSI (Intacytoplasmic sperm injection)
Intracytoplasmic sperm injection (ICSI) can be used as part of an invitro fertilisation (IVF) treatment to help you and your spouse to conceive a child. ICSI is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments. ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb).
How is ICSI carried out?
As with standard IVF treatment, you will be given fertility drugs to stimulate your ovaries to develop several mature eggs for fertilisation. When your eggs are ready for collection, you and your spouse will undergo separate procedures.
Your spouse may produce a sperm sample himself by ejaculating into a cup on the same day as your eggs are collected. If there is no sperm in his semen, doctors can extract sperm from him under local anaesthetic. Your doctor will use a fine needle to take the sperm from your spouse’s:
- epididymis, in a procedure known as percutaneous epididymal sperm aspiration (PESA), or
- testicle, in a procedure known as testicular sperm aspiraction (TESA)
If these techniques don’t remove enough sperm, your doctor will try another tactic. He’ll take a biopsy of testicular tissue, which sometimes has sperm attached. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is carried out with a microscope. TESE is sometimes carried out before the treatment cycle begins, and under local anaesthetic. The retrieved sperm are frozen. Any discomfort felt by your spouse/ partner should be mild and can be treated with painkillers. After giving you a local anaesthetic, the doctor will remove your eggs using a fine, hollow needle. An ultrasound helps the doctor to locate the eggs. The embryologist will then isolate the individual sperm in the lab and inject them into your individual eggs. Two days later the fertilised eggs become balls of cells called embryos. The procedure then follows the same steps as in IVF. The doctor transplants one or two embryos into your uterus and through your cervix using a thin catheter. If you are under 40 you can have one or two embryos transferred. If you are 40 or over you can have a maximum of three embryos transferred if using your own eggs, or two if you’re using donor eggs. If there are any extra embryos they may be frozen in case this cycle isn’t successful.
Embryos may be transferred from two to five days after fertilisation. Five days after fertilisation the embryo will be at the blastocyst stage. If you’re just having one embryo transferred (called elective single embryo transfer, or eSET), having a blastocyst transfer can improve your chances of a successful, healthy, single baby. If all goes well, an embryo will attach to the uterus wall and continue to grow to become a baby. After about two weeks, you will be able to take a pregnancy test.
How long does ICSI treatment last?
One cycle of ICSI takes between four weeks and six weeks to complete. You and your spouse can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You’ll go back anywhere between two days and six days later for the embryo transfer procedure.
