THE INTRACYTOPLASMIC SPERM INJECTION PROCEDURE

Intracytoplasmic sperm injection (ICSI) is procedure used to treat sperm-related infertility problems. This process is performed by a single sperm being harvested, and inserting it into a fully developed egg. If the egg fertilizes and develops into a good quality embryo it will be inserted into the woman’s uterus. ICSI is used for  male is infertility, for men with little or no sperm present, prior failed fertilization on a IVF attempt, PGD, for patients using donor sperm with IVF, and for those with unexplained infertility that have failed to conceive with inseminations.

The ICSI Procedure

The sperm must be collected for ICSI, which done either of two ways. A self-generated specimen is submitted, either at home or in a room at the fertility clinic. Another option is surgery, where there is a small incision made on the testicle. This method is usually used when there is a blockage or birth defect. There is often genetic testing done to ensure that the male is healthy and free of congenital defects if a sperm extraction procedure is needed.

The egg will have to be collected, so the woman is put on FSH (follicle stimulating hormone) and or HMG, which puts her into superovulation where several eggs are created at once. After the first week, the doctor will make sure that the eggs are maturing on the follicles and check the blood’s estrogen levels. During the second week, the Denver fertility clinic doctor will adjust your medciation dosage based on your response to the medications.

If things are developing, the woman may be given HCG (human chorionic gonadotropin) to help the follicles mature. It will be about a day and half later that the eggs will be collected by a needle aspiration. The needle aspiration is guided by an ultrasound, which takes it through the abdomen and into the ovaries.

With the fertilization process, a holding pipet, under a microscope, will hold the egg while an injection pipet injects sperm into the egg. Several eggs are cultured overnight, and the next day, the eggs are checked for signs of fertilization. For the next 3 to 5 days, the fertilized eggs (embryos) are grown in a culture. One or two of the embryos will be chosen as best candidates and placed in utero. The rest of the embryos will be frozen for more attempts if needed.

Risks and Side Effects of ICSI

There are several risks when it comes to ICSI and other assistive reproductive technologies. It’s best to be aware of anything that may happen and stay informed. Superovulation can cause ovarian hyperstimulation syndrome (OHS), which makes the ovaries swell and painful. This can be minimized by adjusting hormone levels. On average, 1/4 of the women on drugs for fertility get a mild form of OHS, and an even smaller portion get severe symptoms.

There is also a high risk of multiple babies with intracytoplasmic sperm injection. About 35 percent of assisted pregnancies end up with multiples being born. Multiples are always high-risk for the baby and mother. For an older woman over the age of 35 to conceive, she is often given more fertilized eggs than someone younger. This may increase the chance even higher for multiples.

Genetic Counseling and Fertility Consultation

Men with little or no sperm should always be tested for genetic problems. This treatment, while effective, may carry the risks for genetic issues. Those with genetic problems can go through counseling in order to talk about the risks for their future children. If there is concern for this, the Denver reproductive endocrinologist can perform pre-implantation genetic diagnosis, and some genetic problems can be diagnosed in embryo form.

Consider writing down things before you go to talk to your fertility doctor about the ICSI procedure. Write down family history of diseases such as diabetes, cancer, and high risk diseases such as STDs. Keep a detailed record of your medical history on hand, as well as one for your partner, if he will be participating in the procedure with you. Write down any concerns, fears, or hopes so that your doctor can know these and talk about them with you.

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