ICSI Intracytoplasmic Injection
Intracytoplasmic Injection (ICSI) is an assisted reproduction technique included in the treatment of IVF that has allowed successful pregnancy in couples diagnosed with a severe male factor.
The male should provide a sample of semen or a testicular biopsy – if necessary – to extract and select the best sperm that will be used for the fertilization of the oocytes.
Indicated for:
- Men with low sperm count, mobility problems or bad morphology of them
- Infectious disease or infertility of immune cause.
- Cases of cryopreserved samples of vasectomized men or those undergoing radio or chemotherapy treatment. They are very valuable samples because they have a limited amount and the ICSI allows to optimize their use.
- Men who have had a vasectomy.
- Difficulty to achieve an ejaculation in normal conditions, as in retrograde ejaculation (neurological problems, diabetes).
- Other factors: repeated failure after several cycles of IVF and AI, low number of oocytes after follicular puncture or when it is necessary to identify healthy embryos in case of Preimplantation Diagnosis (PGD).
What is the procedure?
Intracytoplasmic injection allows the direct union of the ovule and the sperm, facilitating fertilization. A spermatozoid with low mobility or bad morphology would have greater difficulty to achieve it naturally or through the classical IVF technique.
1- Ovarian Stimulation
The ovarian stimulation in IVF consists in the administration of some daily injections that will get the ovaries, instead of producing a single ovule – which is what they do spontaneously every month -, produce more oocytes to be able to get more number of embryos. The treatment is performed within the clinic and lasts between 10 and 20 days, depending on the protocol used and the speed of response of each patient. During the same, serial ultrasounds (about 3 or 4) are performed and the blood estradiol is determined to verify that the growth and evolution of the follicles is adequate.
2- Follicular Puncture and laboratory
When it is verified by means of ultrasound that the follicles have reached the appropriate size and it is considered that an adequate number of ovules is already available, the follicular puncture is scheduled around 36 hours after the administration of an hCG hormone injection that induces the oocyte maturation in a similar way to how it takes place in the natural cycle. The puncture is performed in the operating room and under sedation, so that the patient does not feel any type of discomfort during the procedure, which lasts approximately 15 minutes.
ICSI
Once we have the ovules after performing the follicular puncture and we have selected the sperm with better mobility and morphology, we will proceed to the microinjection of the ovules. During the process in which the ICSI will be performed, the selected sperm is placed inside a tiny pipette and injected directly into the ovule. In this way, we facilitate the fertilization to the maximum and the obtained embryos will be developed during 3 to 5 days in the Laboratory, before being transferred again to the uterus.
Embryo culture in the laboratory
The resulting embryos after the fertilization of the ovules are observed in the laboratory day after day, and are classified according to their morphology and capacity for division. Some embryos may become blocked in their development, and will be discarded when considered as non-viable.
3. Transfer
The transfer involves the introduction of the best embryos into the womb with the help of a specially designed cannula. The procedure is carried out in the operating room, although in this case it is not necessary to perform sedation, since it is a quick and painless process.
4- Vitrification of remaining embryos
Once the embryo transfer has been carried out, the vitrification of the good quality non-transferred embryos is carried out, in order to be used in a subsequent cycle without the need for ovarian stimulation.
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