ICSI(Intra cytoplasmic sperm injection)
ICSI is a micromanipulation procedure whereby a single sperm is injected into the single egg with the help of small micro needle with the help of robotic machine called micromanipulator. Super ovulation, follicular monitoring, ovum pick up is done like that in IVF. This technique may provide men who have very small amounts of weak sperm (too small for routine IVF) a chance to fertilize individual eggs. When the egg is fertilized, the embryo is inserted into the uterus.
ICSI can be used when:
• The number of sperm available is too few to expect fertilization; ie very low sperm count & motility,
• Fertilisation has not occurred in previous IVF cycles despite a high number of sperm being present;
• The only sperm available are those which have been collected direct from the testis. e.g. in cases of congenital absence of vas or obstructive azoospermia.
• Repeated IVF failures,
• If not enough eggs could be retrieved from the woman as in woman with advance age and unexplained infertility cases
ICSI / IVF splits
Sometimes, it is not possible to say in advance whether ICSI will be necessary to achieve fertilisation of eggs. An ICSI / IVF split involve treating half of the eggs with ICSI and half with IVF. In this way we can find out if ICSI is really necessary while still ensure that if IVF does not work at least some fertilized eggs are available for transfer. An ICSI/IVF split is normally only done if 12 or more eggs are collected. If fewer eggs than this were collected then ICSI would be carried out on all the eggs.
The finding of azoospermia (zero sperms in semen) on repeated semen examination is a great blow on the couple’s aspirations for parenthood. Fortunately science has advanced so much, to offer realistic hopes to these couples to father their own genetic child. Except for primary testicular failure, where spermatogenesis is arrested’ all other causes of azoospermia can be benefited by IVF-ICSI-TESE/PESA. Here sperms are retrieved from the testes and injected into the cytoplasm of oocyte so as to fertilize them.
When the diagnosis of azoospermia is confirmed, complete evaluation including thorough history and physical examination is done by the urologist, so as to find out the cause of azoospermia. This needs to be backed by some investigations like S. FSH, S. Testesterone, USG scrotum etc. Finally to confirm whether mature sperms are there in the testes or not, testicular biopsy is required. This is done under general anaesthesia and if mature sperms are found in biopsy, the testicular tissue is then frozen and saved so that it can be used in subsequent IVF-ICSI cycles, thereby omitting the need to do repeated TESE or PESA at the time of egg retrieval.