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Intracytoplasmic sperm injection occurs in
conjunction with an ART cycle and consists of the micromanipulation
of sperm and eggs. In ICSI, a single sperm is injected directly
into each egg.
ICSI is used for a variety of infertility conditions
including moderate to severe
male factor, advanced
female age, tubal
disease, and unexplained infertility. The male may have
a low sperm count, poor motility, or other sperm abnormalities.
Antisperm antibodies may be present in the male or female.
These antibodies mistake sperm for pathogens and seek to
destroy them.
In an ICSI cycle, IVF
is performed in the usual manner of follicle stimulation
and subsequent egg retrieval. Once the egg(s) have been
retrieved they are prepared for sperm injection. The sperm
are specially prepared, cleansed, and placed into a special
solution for manipulation. After the sperm and egg have
been prepared, the sperm is drawn tail first into a micropipette.
A micropipette is a tiny glass tube shaped like a needle
that is used to inject the sperm directly into the egg.
The egg is held in place under the inverted
microscope using another small smooth glass tube that has
a very small amount of negative pressure. Once the egg has
been secured on the end of the holding pipette, the injection
pipette (containing the sperm) is introduced into the cytoplasm
(cellular material inside the egg) of the egg. The injection
is performed with a device called a "micromanipulator"
which holds the "ICSI tools" in place.
Following the injection of the sperm into the
egg, the resultant embryo(s) is incubated from 3- 5 days.
Extra  embryos
may be frozen (cryopreservation) for use in future cycles.
ICSI has made pregnancy possible for many couples
who otherwise had no hope of creating a genetically related
offspring. To date, the resulting "ICSI babies"
do not have a higher incidence of chromosomal abnormalities
or birth defects.
There are some conditions that, if present
in the parents, make genetic counseling necessary. One such
condition is congenital absence of the vas (the tube that
transports sperm in the male reproductive tract). This condition
has been associated with the risk of cystic fibrosis. Also,
some men whose sperm cannot fertilize an egg may have a
condition called microdeletion of the Y chromosome. This
condition will probably cause a male baby to be infertile
and require ICSI to reproduce.
Pregnancy rates with ICSI are markedly
improved and much better than the previous micromanipulation
procedures. Early procedures offered only slight improvement
over IUI (intrauterine
insemination) whereas ICSI brings fertilization near
to normal.
The need for donor sperm insemination has decreased dramatically
with the advent of ICSI. The costs associated with IVF/ICSI
are significant, especially in states without mandated infertility
coverage. A major component of cost is injectable ovulation
induction drugs (FSH).
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