Dr. Anu Sidana who is one of the best gynecologist in Gurgaon explains ICSI or Intracytoplasmic Sperm Injection as a form of IVF (in vitro fertilization). According to Dr. Sidana, it is most commonly used in cases of extreme male infertility, after oocyte preservation (egg freezing), or after repeated failure with the conventional IVF attempts.
According to Dr. Mohit Saraogi who is one of the best IVF specialist in Mumbai, the typical use of ICSI is extreme male infertility, which includes:
- Oligospermia or extremely low sperm count.
- Teratozoospermia or abnormal shape of the sperm.
- Asthenozoospermia or poor motility of the sperm.
In case a person is producing sperm but his ejaculate doesn’t contain any sperm, it’s possible to retrieve the sperms via TESE or testicular sperm extraction. When TESE is applied for sperm retrieval, it’s necessary to use ICSI. The treatment is additionally used when retrieval of the sperm is completed from the urine of the person, i.e., just in case of retrograde ejaculation.
While male infertility remains the primary reason for the utilization of ICSI, it isn’t the sole one. Other reasons include:
- Lack of fertilized eggs during prior IVF cycles: If the eggs are retrieved in good numbers and therefore the sperm count appears to be healthy also, but the eggs don’t fertilize, then ICSI is an option during the next cycle of IVF.
- Use of frozen oocytes & frozen sperm: Just in case of egg vitrification, the shell of the eggs becomes harden by freezing. Fertilization becomes difficult ICSI can overcome such complications. ICSI is also suggested if the frozen sperms don’t look active.
- Preimplantation Genetic Diagnosis (PGD): The IVF technology that permits the embryos to be genetically screened is understood as PGD. If that’s being done, the utilization of conventional fertilization techniques may cause the sperm cells that haven’t embryo to still be around the embryo. This might cause interference with accurate results of PGD.
- In vitro maturation (IVM): IVM is basically an IVF technology that involves retrieval of eggs from the ovaries before its complete maturation. The last stages of maturation are completed within the lab. Certain researches have evidenced that the speed of fertilization of IVM eggs by sperms is relatively lower than standard IVF. There’s a requirement for more researches to be done on this, but it’s always the best choice to accompany ICSI just in case of IVM.
The benefits of ICSI are evident in numerous situations and it’s definitely a superb technology when the necessity arises. However, there are situations where success rates are still not high. Which includes:
Controversial Uses Of Icsi:
- Eggs retrieved in lower numbers: When there are few eggs, there’s a risk that fertilization won’t occur. ICSI could be a viable option during this case but there isn’t any evidence that birth or pregnancy rates are improved with the utilization of ICSI.
- Unexplained infertility: Just in case of unexplained infertility, the explanation for infertility is unknown. To beat it ICSI is certainly one among the ways to opt for. However, there’s no evidence that the success rates with live births improved when ICSI was used for unexplained infertility.
- Higher maternal age: Currently, there’s no evidence stating the impact of high maternal age on fertilization rates. So, ICSI won’t be necessary.
- Routine use of ICSI with IVF: It’s believed by some doctors that ICSI should be used for each patient simply for eliminating the likelihood of failure with fertilization. However, there is no significant research supporting this claim.
Are There Any Risks Involved?
The procedure of ICSI is universally considered to have less number of associated risks. However, ICSI does accompany a group of its own risks and drawbacks. Once the sperm is obtained, the male partner isn’t susceptible to any risk from the procedure. Some known ICSI risk factors include:
- Embryo damage: Not all eggs that fertilize finish up developing into healthy embryos. It’s possible for a few embryos and eggs to get damaged during the method of ICSI.
- Multiple pregnancy: Couples using ICSI alongside IVF have a 30-35% increased chance of conceiving twins and 5%-10% chances of getting triplets. When the mother carries twins or triplets, there are increase risks of few complications during pregnancy and childbirth.
- Birth defects: The danger of birth defects is increased slightly with ICSI treatment, although it is rare nonetheless. Some birth defects related to ICSI are Angelman syndrome, Beckwith-Wiedemann syndrome, chromosome abnormalities, and hypospadias. Also, the danger of a male child having fertility issues increases slightly as there’s an opportunity for genetic transfer of infertility.
It is due to these additional risks a lot of doctors don’t recommend the utilization of ICSI with every IVF cycle. It’s understandable if ICSI is an absolute requirement for conceiving. If that’s the case, confirm you consult your doctor regarding the benefits and drawbacks of using the technology. The success rate of the procedure completely depends on the individual patient and their health condition. Regardless, research shows that 25% of patients can conceive after only one attempt at ICSI. The procedure should be considered as to how to mingle the sperm and the egg, not as an assurance of pregnancy.