Intracytoplasmic Sperm Injection (ICSI)

Treatment Overview

Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat certain infertility problems, such as sperm-related infertility. ICSI is used to enhance the fertilization phase of in vitro fertilization (IVF) by injecting a single sperm into a mature egg. The fertilized egg is then placed in the uterus or fallopian tube.

Sperm collection

If sperm can't be collected by means of masturbation, they are surgically removed from a testicle through a small incision. This method may be used when there is a blockage that prevents sperm from being ejaculated or when there is a problem with sperm development. People with little or no sperm in their semen (not due to a blockage) may have genetic testing before they start ICSI to screen for genetic problems.

Ovulation and egg retrieval

To prepare for a procedure using your own eggs, you will likely get daily hormone shots and be closely monitored for about 1 to 2 weeks. Your doctor will check your blood estrogen levels and use ultrasound to see how your follicles are developing. Your dose may change based on test results. If follicles fully develop, you are given a human chorionic gonadotropin (hCG) shot to stimulate the eggs to mature. The mature eggs are collected 34 to 36 hours later. This is done using laparoscopy or needle aspiration guided by ultrasound.

Sperm injection and transfer

A tool is used to hold an egg in place. A tiny tube is used to put one sperm into the egg. After culturing in the lab overnight, eggs are checked to see if they've been fertilized. After incubation, the eggs that have been successfully fertilized or have had 3 to 5 days to further develop are selected. One or more are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. Your doctor will recommend how many embryos to transfer, based on your age and other information about you. The other embryos may be frozen for future use.

Why It Is Done

ICSI can be used to help fertilize an egg during infertility treatment. This is often done when there are sperm-related infertility issues, such as little or no sperm in the semen.

ICSI can be used even if infertility is not related to a problem with sperm. Some choose to try ICSI after repeated in vitro fertilization has not worked.

ICSI is also used for those who are planning to test the embryo for certain genetic problems. ICSI uses only one sperm for each egg. So there is no chance the genetic test can be contaminated by other sperm.

How Well It Works

When done using eggs of good quality, ICSI can help improve fertilization rates for people with sperm-related infertility. Once fertilization occurs, the chance of giving birth is about the same for people who have in vitro fertilization (IVF) with ICSI and people who have IVF without ICSI.

Risks

Risks related to ICSI are the same as for in vitro fertilization.

• Superovulation with hormone treatment can cause severe ovarian hyperstimulation syndrome. Your doctor can reduce the risk of this problem by closely monitoring your ovaries and hormone levels during treatment.
• The risk of conceiving a multiple pregnancy is directly related to the number of embryos transferred to the uterus. Multiple pregnancies are high-risk for both you and your babies.

There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as ICSI. Talk with your doctor about these risks.

Treatment success versus the risk of multiple pregnancy

If you are over 35, you may choose to have more embryos transferred than someone who is younger. This will give you the best chance of getting pregnant using your own eggs and having a healthy pregnancy. But this increases your risk of multiple pregnancy.

Because of the risks to the babies of multiple pregnancy, experts recommend that you limit the number of embryos transferred. Your doctor will recommend a certain number of embryos based on your age and other factors.

If you are over age 40, there is a high rate of embryo loss when using your own eggs. Donor eggs may work better.