When is ICSI the only option in fertility treatment?

Approximately 30% to 40% of all infertility cases are due to a male factor, and in the majority of cases, male infertility is due to problems with the sperm. The treatment of male infertility has been revolutionised by a medical procedure called Intracytoplasmic Sperm Injection (ICSI) and to date, tens of thousands of children have been born around the world as the result of ICSI.
In this article, we find out what ICSI is, who it is for, when it is the only option in fertility treatment, and where this treatment is available.

Still considered as one of the major breakthroughs in the treatment of infertility, Intracytoplasmic Sperm Injection (ICSI) was first used in 1992 in Belgium.

The technique was developed by Gianpiero Palermo at the Vrije Universiteit Brussel, in the Center for Reproductive Medicine and, for 30 years, has offered an alternative to donor sperm for those who have severe male infertility.

Because just a few normal sperm are needed for conception using ICSI, even men who were previously seen as completely sterile now have an excellent chance to have their own biological child.

What is ICSI?

ICSI is used as part of In Vitro Fertilisation (IVF) treatment process.

A quick overview of an IVF cycle will help clarify where ICSI fits into the IVF fertility treatment process.

In the simplest terms, IVF treatment is a process in which the egg and sperm are fertilised outside of the body in the lab to form an embryo, which is then transferred to the uterus to hopefully implant and become a pregnancy.

ICSI is used during the fertilisation process in the lab to provide better fertilisation rates in cases where there is very little sperm or the sperm is of low quality for various reasons.

During standard IVF treatment, the egg and between 50,000 and 100,000 sperm are placed in the same glass dish in the lab. The sperm are left to naturally fertilise the egg by penetrating the egg of its own accord.

However, for many reasons, there may not be 50,000 to 100,000 sperm available, or the sperm available may not be able to reach the egg or penetrate the egg.

This is where ICSI comes into play: during ICSI, a single carefully selected and prepared sperm is directly injected into a carefully selected and prepared egg.

Using a microscope and an advanced sophisticated micromanipulator, ICSI enables embryologists to select a single good quality sperm and to pick it up with a very fine injection pipette. This sperm is then very gently injected straight into the egg.

The egg is then put back into culture and into the incubator. After 16 hours, the injected egg will be evaluated for signs of fertilisation. The signs of fertilisation under a microscope is two polar bodies, and two pronuclei.

You can watch a video of the ICSI treatment process being performed at Medfem Fertility Clinic – one of the pioneers of IVF and ICSI treatments in South Africa – here…

ICSI treatment has a rate of fertilisation around 70%. While ICSI does not absolutely guarantee fertilisation, the rate of complete failed fertilisation is very low and is most common in cases with limited egg supply.

Who is ICSI for?

ICSI is usually offered to couples who have had poor or no fertilisation during standard IVF when the sperm and the egg are allowed to fertilise naturally in the lab, or when fertilisation is less likely to occur with routine IVF.

This can be due to a number of reasons, including severe male factor infertility, which includes:

* Low sperm count (oligozoospermia)
* Poor sperm morphology – referring to abnormally shaped sperm
* Few normal sperm (teratozoospermia)
* High CMA3 – immature DNA
* Poor sperm motility – referring to slow moving sperm (asthenozoospermia)
* An obstruction preventing sperm release – a vasectomy or a blockage caused by disease, injury or a genetic condition that prevents sperm reaching the ejaculate (obstructive azoospermia)
* Antisperm antibodies that are produced by the man’s body and inhibit sperm function
* Vasectomy reversals, resulting in very low sperm counts or poor-quality sperm production.

The sperm may also be unable to penetrate the egg for various reasons. A mature, healthy sperm has the ability to bind or attach to hyaluronan, a key component of the group of cells that surround an egg. If a sperm is not be able to bind to the egg, it will not be able to penetrate the egg and there will be no fertilisation. A HBA test will determine if sperm is able to penetrate an egg.

Because ICSI involves the injection of only a single selected sperm into each egg, even the most severe of male factor abnormalities can be overcome – even if only one or two sperm cells can be surgically retrieved.

Where necessary, sperm can be retrieved surgically directly from the epididymis or the testes with a very fine needle, using the approaches briefly described below.

* Testicular Sperm Aspiration (TESA) – sperm tissue is extracted by a fine needle passed through the skin of the scrotum.
* Percutaneous Epididymal Sperm Aspiration (PESA) – extracting sperm-containing fluid from the epididymis to overcome an obstruction of the sperm duct.
* Microsurgical Epididymal Sperm Aspiration (MESA) – opening up the ducts of the epididymis and extracting fluid or a piece of testicular tissue to extract live sperm through a fine needle.
* Testicular Sperm Extraction (TESE) – through a small incision, a piece of testicular tissue is removed to obtain sperm.

When is ICSI the only option?

ICSI may be the only option for couples when the sperm quality is too low for standard IVF due to a low count or low motility, or where previous IVF cycles have failed.

It is also the only option when sperm has been obtained surgically directly from the testicles (TESA) or epididymis (PESA), where there is high DNA fragmentation in sperm or where the eggs have been previously frozen.

Where to get ICSI treatment

ICSI treatment is available in South Africa at advanced fertility clinics such Medfem Fertility Clinic, where ICSI, IVF and other fertility treatments are provided by a team of highly qualified and experienced fertility experts and embryologists; and trained, qualified theatre staff, nurse practitioners, clinical psychologists and specialist pharmacists in state-of-the-art facilities equipped with advanced technologies to maintain a leading pregnancy success rate.

At Medfem we believe in helping you reach your family dream through:

* World-Class Fertility for Everyone – we believe in making world-class fertility treatments available for everyone

* A Positive Fertility Journey – It is our joy and commitment to give you a positive outcome to your fertility journey

* Delivered With Empathy & Caring – So you may have a fond memory, of a feeling of empathy, caring and being part of the Medfem family

If you would like to meet one of our fertility specialists at Medfem Fertility Clinic, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

Our Fertility Specialists can also meet with You During a Virtual Consultation Via Zoom or Skype. Click here to book a virtual consultation now.
We look forward to meeting you at Medfem Fertility Clinic!


Spread the love