What is ICSI?
ICSI stands for Intracytoplasmic Sperm Injection and it is used for couples to achieve fertilization. It is used when the male is infertile or when couples have failed to get pregnant through IVF attempts. It allows couples who currently have little hope of becoming pregnant to obtain fertilized embryos. At UCSF, fertilization rates have been between 70-80% of all eggs injected. The pregnancy rates have been comparable to those seen with IVF in couples with no male infertility.
History and Use
ICSI was first used at UCSF in 1994 and the first birth was in February of 1995 using this technique. The technique involves the very precise process of taking a single, live sperm and injecting it directly into the center of a human egg. The woman has to have ovarian stimulation with fertility medications so that there will be a few mature eggs (this is part of the IVF process). These eggs are then removed through the vagina using vaginal ultrasound and kept in an embryology laboratory. The semen sample is prepared, after it is obtained, through centrifuging. This will separate the sperm from debris so that the micromanipulation specialist can then select one live sperm and place it directly into the egg.
Who Uses ICSI?
While ICSI is only completely necessary in cases where there is male factor infertility with abnormal semen issues, in the Bay Area where ICSI was developed, approximately 75% of all IVF cases are now using ICSI. Patients are choosing this route because of previous disappointments with regular IVF, decreased numbers of eggs to fertilize, and other reasons.
Risks with ICSI
There are several risks with ICSI that couples should be made aware of. During the ICSI procedure, it is possible for a small number of eggs (usually less than 5%) to be permanently damaged from the ICSI needle insertion. The risk of having a baby with abnormal chromosome problems is four times the average seen with spontaneous conception. Problems with sex chromosome abnormalities can result in many problems including increased risk of miscarrying, heart problems for infants that may need surgery, increased chance of behavior or learning problems and increased risk that your children will have their own fertility issues when they grow up. The risk for other chromosomal issues, such as Down's Syndrome, is not increased due to ICSI.
Thinking about ICSI
If you have been told that you have any abnormalities with sperm test results, then you should definitely consider using ICSI. Without ICSI, the risk of poor fertilization is quite high for couples with any sperm abnormalities. With ICSI, the chance of having a baby becomes much higher. Similarly, if the man has had a vasectomy reversal, ICSI is also recommended because of the sperm antibodies that can affect fertilization.