Intracytoplasmic Sperm Injection Treatment in Delhi, India

Intracytoplasmic sperm injection, an infertility treatment, is a specialised technique used during in vitro fertilisation (IVF), primarily used for the treatment of male infertility. ICSI is a procedure of injecting a single sperm directly into the egg.

Before fertilisation takes place, the head of the sperm needs to be attached to the outer layer of the egg. The sperm then penetrates the outer layer to the inside of the egg, where fertilisation occurs. The inside of the egg is called cytoplasm.

Sometimes, the sperm may not be able to penetrate through the outer layer for a variety of reasons, such as a thick outer layer or the sperm's inability to swim. In such situations, intracytoplasmic sperm injection is considered along with IVF treatment to fertilise the egg.

When is an Intracytoplasmic sperm injection needed?

The intracytoplasmic sperm injection procedure is a part of IVF and is needed in case of infertility or severe fertility problems when the sperm doesn't penetrate the egg on its own.

• Using previously frozen eggs
• Blockage in the male reproductive tract can keep the sperm from getting out
• Inability to ejaculate (anejaculation)
• The problem of sperm's inability to attach to the egg
• Slow sperm movement (asthenozoospermia)
• abnormal shape of the sperm (teratospermia)
• Low count of sperm production (oligospermia)

Diagnosis 

The gynaecologist will collect the eggs and sperm. The process for egg retrieval includes:

• Egg retrieval: The gynaecologist will use transvaginal ultrasound technology to insert a thin needle into the wall of the vagina and the ovaries. For the procedure, mild anaesthesia may be given. A device attached to the needle collects the eggs

• Ovarian stimulation: A woman will receive medication injections for 8 to 14 days before retrieving the eggs. The medication stimulates the ovaries to produce multiple eggs and to mature faster

The process of sperm retrieval:

• A man supplying the sperm has to abstain from masturbation and sex for two or three days before sperm collection 
• Masturbating on the day of retrieval, collecting the ejaculate into a container. The sperm must be sent to the laboratory within 1 hour from ejaculation

A test for semen analysis is conducted to check sperm volume, quality, and mobility. In case of vasectomy reversal or other health conditions, procedures such as microscopic testicular sperm extraction or electroejaculation may be performed to extract the sperm. Alternatively, frozen and stored sperm can also be used for IVF and ICSI treatment.

Treatment of IVF

A gynaecologist who is a reproductive endocrinologist performs an intracytoplasmic sperm injection procedure.

ICSI uses specialised micromanipulation tools, equipment, and microscopes to select individual sperm in a special ICSI needle. In the intracytoplasmic sperm injection process, a tiny needle micropipette is used to inject a single sperm into the centre of the egg. Once it is fertilised, the fertilised egg, also called an embryo, is kept under observation in the laboratory for five days before transferring to a woman's uterus. The embryo is transferred through a catheter placed in the cervix.

The procedure of ICSI is as follows:

• A special holding pipette is used to hold the mature egg
• A thin, delicate and sharp needle is used to pick up and immobilise one single sperm
• The sperm used on the needle is carefully inserted into the shell of the egg and into the cytoplasm of the egg
• Once the sperm is injected into the centre of the egg, the needle is carefully removed
• The eggs are kept under observation to ensure the process of fertilisation occurs

Who Are the Best Candidates for Surgery?

ICSI has 50 to 80% of positive results.

Anyone who faces infertility issues or has problems conceiving can opt for IVF and ICSI methods. The best candidates for ICSI are males with severe infertility, females after egg freezing, and failed attempts of fertilisation with conventional IVF. A person may benefit from ICSI if:

• Older than 35
• The traditional IVF method was unsuccessful

Who Should Not Consider Surgery?

Anyone who has had unsuccessful treatment in the past for poor-quality sperm and immature eggs is unlikely to benefit from ICSI and IVF.

How to Prepare for Surgery?

Intracytoplasmic sperm injection is an easy procedure and doesn't need any preparation. However, if any instructions are given by the gynaecologist, follow their instructions.

•  Do not masturbate or ejaculate
• Take given medications on time

Possible Complications

ICSI may cause a few complications:

• The embryo may stop developing in the laboratory or even after transferring into the womb
• Damage to a few or all eggs during needle penetration
• Unfertilised even after sperm injection

ICSI can cause complications in children, similar to natural pregnancy, however, birth defects are slightly higher in ICSI than in natural conception. Some children are born with birth defects that most likely occurred due to ICSI and IVF. They are:

• Angelman syndrome
• Hypospadias
• Sex chromosome abnormalities
• Wiedemann syndrome
• Higher risk in a boy baby of having infertility issues in future
• Intellectual disability
• Autism

Taking Care of Yourself After Surgery

After ICSI and IVF, the doctor may recommend bed rest for a few weeks.

• Take good rest: Do not exert or perform heavy physical activity
• Eat healthy food:Consult a dietician and eat healthy and nutritious food rich in carbohydrates and vitamins
• Medicines: Take the prescribed medicines on time

Review

Reviewed by Dr. Sweta Gupta, Director - Infertility & IVF.