Intracytoplasmic Sperm Injection (ICSI) is a specialized form of IVF. This is used primarily for the treatment of severe cases of male-factor infertility. This is a process whereby carefully selected healthy sperms of husband are injected inside wife’s egg under the special microscope and it is kept along with special nutrients required for survival and growth in a specialized incubator which mimics the human body temperature & conditions to help the sperm injected egg to form an embryo.
When does a couple need ICSI cycle:
- Male: Low sperm count.
- Male: Low sperm morphology or motility.
- Male: Anti-sperm antibodies or have previously had a vasectomy or unsuccessful vasectomy reversal.
- Female: Low AMH count (Anti-Mullerin hormone) or low egg capacity
- Female’s age more than 35.
- Unexplained Infertility.
Standard ICSI Procedure
• Day 2 - Superovulation is done to produce multiple eggs. Hormonal injections are used for superovulation.
• Day 10-12 - Oocyte when matured, picked up under general anaesthesia. Kept in incubator for 2 hours.
• Day 13 – check for denudation of oocytes. If oocyte cumulus has denuded, it is taken under micromanipulator & injected with single sperm through sperm injection needle.
• Fertilization & embryo formation is checked.
• D3 OR D5 – Fertilization is checked and if successful, blastocyst, embryo grown to 100 cells approx, is placed in the uterine cavity.
Improvised ICSI procedure at Akruti IVF Centre for better success rate:
• On D1 of menses, Blood test (LH, E2, Progesterone) are given for wife.
• From D2 of menses, Ovaries are examined on sonography and on blood test hormones are checked. After complete confirmation of hormone settlement, Injections gonadotropins for follicles are started.
• On D6, antagonist are added along with gonadotropins to prevent premature rupture of follicles.
• During this process, husband is asked to give semen sample for freezing and one more fresh sample is collected on the day of Pick up.
• Between D10 – D12, E2, Progesterone blood test are taken and when follicles reach at optimal size of maturity, depending upon the patients medical history and hormone reports injection is given for follicle rupture.
• After 36 – 38 hours, Oocyte retrieval / Pick up is done.
In our lab, our experience embryologist, select the good and healthy sperm and inject directly into egg of wife and keep it in a tray to form a embryo.
Then with the help of Time-lapse machine, the progress of embryos is recorded on hourly basis. Akruti-IVF centre is one of the 5 Centres in India which has this wonderful technique, that records the progress of embryos, basis which it rejects the abnormal embryos and selects and proceeds with good quality embryos.
Depending upon the hormone report and colour doppler record of endometrium, transfer is decided either in same cycle or next cycle of menses.
Procedure duration and waiting time
It takes almost 15 days to complete the procedure, it begins on D2 of menses and ends on D14 or D15.
Does not require admission, you can travel back the same day after ICSI/embryo Transfer, as travelling does not reduce the possibilities of pregnancy.
Medications are advised after Embryo Transfer procedure for 12 - 15 days. Hence it takes 15 – 20 days from the ICSI date to obtain the pregnancy test result.
The success rate of ICSI procedure depends upon the underlying cause of infertility.
• Age of women-ICSI Success rate is more if age is below 35 years.
• AMH capacity and number of oocytes-ICSI Success rate is directly proportional to AMH & number of oocytes.
• DNA Fragmentation of Sperms-ICSI success rate is inversely proportional to DNA Fragmentation of sperms.
• Cause of couple’s infertility.
Standard success rate of ICSI cycle is around 40 % for fresh cycle Embryo Transfer & 60-80% for Frozen Thaw Embryo Transfer.
Akruti IVF centre has a Time Lapse incubator which is used for culture and development of ICSI embryos. Time Lapse plays important role in monitoring the division of Embryos while growing & helps in selection of embryos which improves success rate of ICSI.
That’s why Akruti IVF Centre has success rate of 50-55% in Fresh Embryo Transfer & 80-85% in Thaw Embryo Transfer, which is much higher than standard success rates.