ICSI

icsi
Sperm being deposited
into a human oocyte.

By Angie Best-Boss

If you are preparing for an IVF cycle, one of the questions you may be asked is if you want ICSI done. ICSI is also known as microfertilization. Back in the day, when a man had sub-fertile sperm, there wasn’t much that could be done. Donor sperm was just about the only option. Now, you just need one good sperm to make a cycle successful!

How it works

ICIS (pronounced ick-see) is done during an IVF protocol. Your doc will help you super-ovulate with injectable drugs, then retrieve your eggs through a short surgical procedure.

Once your eggs are removed, the embryologist will physically insert one sperm into one egg (that is the ICSI part - Intracytoplasmic sperm injection). A pipette is used to keep the egg in place and a needle is injected with a single sperm cell in it.

After fertilization, the egg/sperm combination will be allowed to grow and you will be called with a fertilization report the day after retrieval. Either 3 or 5 days later they will transfer 1, 2, or 3 embryos back to your uterus. Then comes the hard part - you wait for 10 days and have a beta blood test to check for pregnancy.

ICSI isn’t Cheap

Adding ICSI to your cycle adds about $1,800 to an average cycle.

Is it for me?

ICSI typically results in normal fertilization in approximately 70-85% of eggs injected with viable sperm and about a 50% successful pregnancy rate.

ICSI may be for you if the male partner has:

  • Antisperm antibodies
  • Severe male factor
  • Had a vasectomy
  • Low or no motility (the sperm don’t swim well) less than 35%
  • Abnormal morphology
  • Previous IVF cycles with no or low rate of fertilization
  • IVF cycles with very low yield of eggs at the egg retrieval - usually 5-6 (or less) eggs

Making the Decision

And there are some risks. As one concerned dad asked, "We cannot help but think that with natural selection we have not been successful in conceiving. How can we clearly assume that the embryologist is selecting what may "look" like a good sperm, but in fact may have a chromosome or DNA abnormality that will cause birth defects?”

Research isn’t clear on whether or not there is an increase in birth defects with ICSI. As one fertility specialist explains, "sperm that are united with eggs that are not good (meaning would possibly cause birth defects) will not make it to the transfer day. Your chances of having a child with birth defects are no greater than if you got pregnant naturally.” Others suggest a 1% greater risk of birth defects.

"Overall, the results are reassuring and lay to rest the fears that have been expressed about the health and welfare of children conceived though IVF and ICSI," says researcher Christina Bergh, of Sahlgrenska University Hospital in Göteborg, Sweden. She indicated some minor differences were found in these areas:

  • ICSI mothers and fathers were more committed to their role as parents than others.
  • Hospital admission rates were slightly higher for ICSI and IVF babies than naturally conceived babies, although the rate of medical illnesses across the three groups was similar.
  • The rate of birth defects was 6.2% and 4.1% for ICSI and IVF babies, respectively, compared with 2.4% among naturally conceived babies. The rates were statistically different only when comparing ICSI children with naturally conceived children, and not by IVF. These differences in malformations were also more commonly seen in boys than in girls. Researchers say all the birth defects were correctable and the children went on to be as normal and healthy as others.

Other researchers suggest that sons conceived by ICSI of men with a Y-chromosome microdeletion will inherit the same deletion and will be infertile. They will require ICSI themselves if they wish to father a child. The only way to get around those risks is to do a PGD, or prenatal genetic diagnosis and evaluate all embryos for certain diseases.

It’s Your Decision

"I did a little research and there are slightly higher risks associated with ICSI. I think ICSI is wonderful for those who need it, but I just didn't want to do it if it wasn't necessary. We are unexplained too. My first RE did ICSI with all of his patients regardless. I ended up doing IVF with a different RE that didn't use ICSI unless it was necessary, and I'm glad we did," explains Mary.


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