Intracytoplasmic sperm injection (ICSI) is one of the most commonly used methods in the in vitro fertilization (IVF) process. This technique involves directly injecting a single sperm into the cytoplasm of the egg cell using specialized microscopes and micromanipulators. It was developed to assist couples who face significant difficulties in conceiving naturally, providing the possibility of having children even in the most complicated infertility cases.
WHEN IS THE ICSI METHOD USED IN INFERTILITY TREATMENT?
The ICSI method is used in specific cases of infertility when there are significant fertilization problems that cannot be successfully resolved with standard IVF procedures. It is applied in the following situations:
Male Factor Infertility: ICSI is the most common solution in cases of male infertility, which may include:
– Low sperm count (oligozoospermia): Insufficient concentration of sperm in the ejaculate.
– Poor sperm motility (asthenozoospermia): Inadequate ability of sperm to move, preventing them from reaching the egg.
– Abnormal morphology (teratozoospermia): A high percentage of sperm with structural abnormalities.
– Azoospermia: Complete absence of sperm in the ejaculate, where sperm may be obtained through surgical procedures such as TESE or MESA.
Fertilization Issues in Previous IVF Cycles: When a standard IVF procedure has failed to fertilize the eggs or the fertilization rate is very low, ICSI is used as an alternative to improve the outcome.
Presence of Anti-Sperm Antibodies: Anti-sperm antibodies can prevent sperm from moving or binding to the egg, making natural fertilization or IVF fertilization very difficult. ICSI bypasses this issue by directly injecting the sperm into the egg.
Poor Egg Quality or Low Egg Count: When the number of eggs is limited or their quality is decreased, ICSI maximizes the use of the available eggs.
Use of Frozen Material: When cryopreserved sperm or eggs are used, their ability to fertilize may be reduced, and ICSI helps overcome this challenge.
Genetic Testing of Embryos: ICSI is often used when couples plan to undergo pre-implantation genetic testing (PGT) to avoid contamination of the embryos by multiple sperm.
Unexplained Infertility: In some cases of infertility, where all tests show normal results but conception does not occur, doctors may choose ICSI to investigate and overcome potential fertilization issues that are not directly observed.
HOW IS ICSI PERFORMED?
The ICSI procedure is complex and requires a high level of expertise from the embryologist. It consists of the following steps:
Preparation of Eggs and Sperm: After retrieving the eggs from the ovaries during the aspiration procedure, they are carefully prepared and placed in the appropriate conditions. Meanwhile, sperm is isolated and the highest-quality sperm is selected.
Microinjection of Sperm: Using high-resolution microscopes and micromanipulators, a single sperm is injected directly into the cytoplasm of the egg.
Incubation and Fertilization: The fertilized eggs are then incubated in the laboratory under strictly controlled conditions to allow the development of the embryos.
Embryo Transfer: After several days (usually three to five), the highest-quality embryos are transferred into the woman’s uterus.
SUBTYPES OF THE ICSI METHOD
In order to improve the chances of successful fertilization and obtain healthier embryos, various variations of the ICSI technique have been developed:
PICSI (Physiological ICSI): The PICSI method involves using hyaluronic acid to select the most mature sperm. Hyaluronic acid is a substance naturally present in the human body and is also a part of the egg cell membrane. In this case, it helps select mature sperm capable of fertilization. This method is recommended for patients with poor sperm analysis results or a history of recurrent miscarriages.
IMSI (Intracytoplasmic Morphologically Selected Sperm Injection): IMSI is an advanced variation of the ICSI method that uses a microscope with magnification up to 6000 times, allowing detailed examination of sperm morphology. The goal is to select sperm without morphological defects, thereby increasing the chances of successful pregnancy.
ADVANTAGES AND LIMITATIONS OF THE ICSI METHOD
ICSI has brought numerous advantages in the treatment of infertility, but it is important to understand its potential drawbacks as well:
Advantages:
– The possibility of fertilization even with a minimal number of sperm.
– High fertilization success rates in laboratory conditions.
– Suitable for various causes of male infertility.
Limitations:
– High cost of the procedure.
– The need for highly trained specialists and specialized equipment.
CONCLUSION
The ICSI method represents one of the most significant achievements in reproductive medicine. Its application allows for the resolution of numerous infertility challenges, especially in cases involving male factors. With innovative subtypes like PICSI and IMSI, this method continues to improve the chances of successful pregnancy and healthy offspring. For couples considering this procedure, it is essential to be well-informed and consult with specialists to choose the best approach for their specific needs.