FERTILITY TREATMENT: INTRACYTOPLASMIC SPERM INJECTION (ICSI)
This involves a single sperm being injected directly into the egg to fertilise it. The embryo is then implanted in the womb.
ICSI developed out of a technique called SUZI (Sub-zonal insemination), where five to ten sperm were injected just underneath the layer of cells, the zona pellucida, that surrounds the egg.
Who Should Have It?
ICSI can be used if your partner’s sperm count is so low that IVF is not possible, if he cannot ejaculate, or if he has an obstruction stopping his sperm being released.
What Happens?
You will have to undergo the same preparations with drug treatment and procedures as for IVF.
The human egg is invisible to the naked eye and sperm are minute in comparison to an egg, so ICSI is a very delicate procedure.
For men who can’t ejaculate or whose sperm are obstructed, the sperm samples can be drawn off directly from the testes or epididymis. If this does not work then a biopsy is performed, in which fingernail-size pieces are taken from the testes through a tiny incision. The sperm retrieved in this way are not fully developed and may not move.
The success rate for ICSI, 20-25 per cent, is slightly higher than for IVF. This is probably due to the fact that the sperm is injected directly into the egg so the technique is not dependent on how well fertilisation takes place.
Risks
In IVF a number of sperm are put in with the egg, which seems to be able to favour healthy sperm over those that may be defective. In ICSI the egg has no ‘choice’ because only one sperm is used and inserted directly. Because of this, and the fact that often immature sperm or even sperm cells are used, there have been concerns that ICSI could result in babies being born with chromosome defects or having genetic problems later in life.
Researchers have found that babies born after ICSI are twice as likely to have a major birth defect and 50 per cent more likely to have a minor defect.
It has been suggested that men go for karyotyping (chromosome evaluation) before they embark on ICSI so that any genetic causes of their infertility can be ruled out. If there is a genetic cause for the man’s infertility, the man and his partner should be counseled as to whether it is right for ICSI to proceed because of the possibility of passing on problems to the baby. Boys born following ICSI might, for instance, be infertile and need ICSI themselves in order to conceive.
It is important to know why the man is infertile, especially if he is producing no sperm. If there are chromosome problems in the man then it is also likely that the miscarriage rate could be high after ICSI.
Sometimes we can’t conceive because nature has a fail-safe mechanism to protect the survival of the fittest. Even though we now have the technology to override this, there are some situations where the consequences for the baby should be thought through carefully.
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Tags: Women’s Health