Intracytoplasmic sperm injection (ICSI) is a laboratory procedure developed primarily to help infertile couples that are undergoing in vitro fertilization (IVF) due to severe male factor infertility. ICSI involves the insertion of a single sperm directly into the cytoplasm or center of eggs using a microinjection pipette (custom-made needle). This is accomplished by the use of a high powered operating microscope which allows us to operate with instruments that are invisible to the naked eye.
A variety of sperm problems may account for male infertility. Sperm can be completely absent in the ejaculate (azoospermia) or present in low concentrations (oligospermia). They may have poor motility (asthenospermia) or an increased percentage of abnormal shapes and forms (teratospermia). There may also be abnormalities in the series of steps required for fertilization, such as sperm binding to and penetrating the egg. Deficiencies in any of these aspects of sperm function can lead to lack of fertilization. ICSI can overcome these deficiencies and result in the same rate of fertilization seen with conventional fertilization techniques.
ICSI is not a perfect technique. Some eggs may be damaged by the ICSI process, particularly eggs of lesser quality. In other instances, the fertilized egg may fail to divide or the embryo may arrest at an early stage of development. The fertilization rate at our facility is nearly 80 percent with ICSI and the live birth rate is similar to that of patients who have conventional insemination used to fertilize their eggs. It is important to note that only eggs that have completed the normal maturation process can undergo ICSI.
ICSI has been utilized since 1992. To date, there is no evidence of an increased incidence of congenital malformations; although, there is no guarantee that abnormalities will not arise later in life. There is a small increase in the incidence of sex chromosome abnormalities (0.8% vs. 0.2%) in children born after ICSI. For example, approximately two percent of men with an abnormal semen analysis will have a microdeletion of the Y chromosome. This genetic abnormality will be inherited by a male offspring following ICSI.
Some Indications for ICSI at IVF New Jersey
- Very low numbers of sperm or poor motility
- The presence of antisperm antibodies (immune or protective proteins which may inhibit sperm function)
- Prior fertilization failure or poor fertilization with conventional insemination
- Frozen sperm collected prior to cancer treatment that may be limited in quantity or quality
- Sperm that has been retrieved surgically when there is a blockage, absence, or abnormality of the ejaculatory ducts that enable sperm to move from the testes
Typically, on the day of the egg retrieval, the IVF New Jersey embryologists determine whether the ICSI procedure will be utilized.