Treatment Overview
Intracytoplasmic sperm injection (ICSI) is an
assisted reproductive technology (ART)
used to treat
sperm-related infertility problems. ICSI is used to enhance the fertilization
phase of
in vitro fertilization (IVF)
by injecting a single
sperm into a mature egg. The fertilized egg is then placed in a woman's
uterus
or
fallopian tube
.
Sperm collection. If sperm cannot be collected by means of masturbation, they
are surgically removed from a
testicle
through a small incision. This method of
sperm retrieval is done when there is a blockage that prevents sperm from being
ejaculated or when there is a problem with sperm development. To screen for
possible genetic problems that could affect offspring, experts recommend that
men with little or no sperm in their semen (not due to a blockage) have genetic
testing before they proceed with ICSI.
1
Ovulation and egg retrieval. To prepare for an
assisted reproductive procedure using your own eggs, you must get daily
injections and be closely monitored for 2 weeks before egg retrieval. At home,
you or your partner injects you with gonadotropin or
follicle-stimulating hormone (FSH)
to stimulate your
ovaries to produce multiple eggs (
superovulation
). After the first week,
your doctor checks your blood estrogen levels and uses
ultrasound
to see whether eggs are maturing in the
follicles
. During the second week, your dosage may
change based on test results and ultrasound. If follicles fully develop, you
are given a human chorionic gonadotropin (hCG) injection to stimulate the
follicles to mature. The mature eggs are collected 34 to 36 hours later using
laparoscopy
or needle aspiration guided by ultrasound
through the abdomen to the ovaries.
Sperm injection and transfer. Under high-power magnification, a glass tool
(holding pipet) is used to hold an egg in place. A microscopic glass tube
containing sperm (injection pipet) is used to penetrate and deposit one sperm
into the egg. After culturing in the laboratory overnight, eggs are checked for
evidence of fertilization. After incubation, the eggs that have been
successfully fertilized (zygotes) or have had 3 to 5 days to further develop
(zygotes or blastocysts) are selected. Two to four are placed in the uterus
using a thin flexible tube (catheter) that is inserted through the cervix. The
remaining embryos may be frozen (cryopreserved) for future attempts.
What To Expect After Treatment
Overall, in vitro fertilization
(IVF)-related injections, monitoring, and procedures are emotionally and
physically demanding of the woman.
Superovulation
with hormones requires regular blood
tests, daily injections (some are quite painful), and frequent monitoring by
your doctor.
These procedures are done on an outpatient basis and
require only a short recovery time. Your doctor may advise you to avoid
strenuous activities for the remainder of the day.
Why It Is Done
Intracytoplasmic sperm injection
(ICSI) is used to treat severe male infertility, as when little or no sperm are
ejaculated in the semen. Immature sperm collected from the testicles are
usually unable to move about and are more likely to fertilize an egg through
ICSI.
ICSI can be used even if a couple's infertility is not related to a problem with sperm. Some couples choose to try ICSI after repeat in vitro
fertilization has been unsuccessful.
ICSI is also used for couples who are planning
to have genetic testing of the embryo to check for certain
genetic disorders
. ICSI uses only one sperm for each
egg. So there is no chance the genetic test can be contaminated by other
sperm.
How Well It Works
Used with in vitro fertilization and
eggs of good quality, ICSI often is a successful treatment for men who have
impaired or no sperm in the ejaculate. ICSI (using sperm collected from the
testicles) produces an estimated 25% to 30% birth rate.
2
Risks
Risks related to ICSI are the same as for in
vitro fertilization, which increases the risks of ovarian hyperstimulation
syndrome and multiple pregnancy.
-
Superovulation
with hormone treatment
can cause
severe
ovarian hyperstimulation syndrome
. Your doctor
can minimize the risk of ovarian hyperstimulation syndrome by closely
monitoring your ovaries and hormone levels during
treatment.
- The risk of conceiving a multiple pregnancy is directly related to the number of embryos transferred to a woman's uterus. Multiple pregnancies are high-risk for both a mother
and her fetuses.
There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as ICSI. Talk with your doctor about these possible risks.
Treatment success versus the risk of multiple pregnancy
For a woman over age 35 to maximize her chances of
conceiving with her own eggs and carrying a healthy pregnancy, she may choose
to have more embryos transferred than a younger woman would. But this increases
her risk of multiple pregnancy.
Because of the risks to the babies of multiple
pregnancy, experts recommend limiting the number of embryos transferred. Your doctor will recommend a certain number of embryos to be transferred based on your age and specific situation.
Women over 40 have a high rate of embryo loss when they use their own
eggs. As an alternative, older women can choose to use more viable donor
eggs.
What To Think About
Doctors advise men who have little
or no sperm in their semen (not due to a blockage) to have genetic testing
before ICSI.
1
Intracytoplasmic
sperm injection is an effective treatment for sperm-related infertility, but it
may carry genetic risks. Couples diagnosed with a chromosomal problem can seek
genetic counseling to learn their potential for having a child with birth
defects.
If you and your doctor are concerned about passing on a
genetic disorder to your child, talk to your doctor about preimplantation
genetic diagnosis. Some genetic disorders can be identified with specialized
testing before an embryo is transferred.
Frozen embryos are often less expensive and
less invasive for a woman, because superovulation and egg retrieval aren't
needed.
Complete the
special treatment information form (PDF)
(What is a
PDF
document?)
to help you understand this treatment.
References
Citations
-
American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). Evaluation of the azoospermic
male. Fertility and Sterility, 90(Suppl 3):
S74–S77.
-
American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). The management of infertility due to obstructive azoospermia.
Fertility and Sterility, 90(Suppl 3):
S121–S124.
Credits
|
By
| Healthwise Staff |
|
Primary Medical Reviewer
| Sarah Marshall, MD - Family Medicine |
|
Specialist Medical Reviewer
| Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology |
|
Last Revised
| December 7, 2011 |
