IVF PRIMER

ICSI (intra-cytoplasmic sperm injection) was initially developed for severe male factor cases when the number and/or function of sperm is not sufficient for standard insemination (Male Factors). The first baby from ICSI at the Alta Bates IVF Program was born in April 1995. Recently the use of ICSI has been extended to couples with milder forms of male-factor as well as couples with unexplained or multi-factorial infertility. The reason for expanding the indications for ICSI is to avoid absent or low which occurs in some of these cases unexpectedly and which can severely reduce the chance of success.

The tests for functional capacity of the sperm (such as semen analysis, strict sperm morphology and the hamster egg penetration assay) do no always predict low or absent fertilization in the laboratory. While uncommon, this can happen even with sperm of men who had previously achieved pregnancy naturally and who have normal semen characteristics. For this reason, we recommend the use of ICSI on some of the eggs in first IVF cycles even in the absence of obvious male factor.

During ICSI, a single sperm cell is injected directly into the egg. The procedure is carried out under a microscope while the eggs are kept on a warm stage at 30°C. During thee injection procedures, micromanipulators are used to reduce hand movements to microscopic movements. The sperm injection pipette is used to immobilize and then to inject the sperm into the egg which is kept in place with a larger holding pipette. After egg retrieval, about 80 to 100% of the eggs are expected to be mature (MII) and ready for sperm injection. A small percentage of the eggs may be damaged by the ICSI procedure. Not all eggs will fertilize after ICSI and some fertilized eggs may not divide into a cleavage stage embryo. Overall, however, the live birth rates with ICSI are comparable to those achieved by conventional IVF. For most couples with severe male factor infertility, ICSI is the only option available to achieve parenthood with their own gametes.

ICSI Procedure

Dr. Andras Szell at micromanipulation table