What is ICSI?
Intra Cytoplasmic Sperm Injection is an ART procedure that involves fertilisation of the sperm and egg outside the body using a micro manipulator and transferring the formed embryo into the uterus for implantation.
The IVF process involves:
- Stimulating growth of multiple eggs
- Egg retrieval outside the body
- Fertilizing the eggs with sperm
- Transferring the embryo back into the uterus.
Who should undergo treatment with ICSI ?
- Women with blocked or damaged fallopian tubes.
- Men with low sperm count
- Several failed IUIs (intra uterine inseminations) .
- Advanced maternal age above 35 years
- Reduced egg reserve or low quality.
- Unexplained infertility.
- Failed IVF (In vitro fertilisation)
How does ICSI improve fertility?
In essence, we are compressing several months of “natural” attempts into one cycle . By transferring fertilized embryos directly into the uterus we are bypassing cervical and tubal causes of infertility.
Hormone stimulation increases the number of eggs produced per cycle.
The best quality embryos are selected by the embryologist.
Depending on several factors , we transfer 2-4 embryos to improve success rates.
How is ICSI performed ?
Hormone medications are given to stimulate ovaries to develop several mature follicles or eggs.
The commonest hormonal protocols are mentioned below
GnRH agonists are started from day 21 of a previous menstrual cycle. Gonadotropins are started from day 3 of current cycle.Gonadotropin dosage is altered depending on the growth of the follicles.We continue gonadotropins until all follicles are 18-20 mm in size.
Gonadotropin stimulation is started from day 3 of the cycle. GnRH antagonists are started after the dominant follicle reaches 14 mm in size and continued until the dominant follicle reaches to 18-20 mm.
GnRH agonists are started on the 1st day of the cycle followed with gonadotropin stimulation on day 3.
When a large number of follicles reach 18-20 mm in size, HCG injection is given to trigger ovulation.The eggs are collected in the operation theatre under general anesthesia 36 hours after the injection.The complete process takes about 15 – 30 minutes depending on the number of follicles.
The patient will be sent back home the same day.
Embryology Lab (ICSI) :
This is the one step where IVF differs from ICSI.
The embryologist uses a micromanipulator to select the best quality sperm and fertilize all the eggs collected.
The embryos thus formed are incubated for 3 or 5 days depending on the type of embryo transfer.
The patient is started on progesterone and estrogen therapy to ready the womb for embryo transfer.
Most clinics “grade” each embryo using one of many scoring systems.
Children born from low-grade embryos are just as competent as those born from high-grade embryos. The only difference is that higher quality embryos result in successful pregnancies.
- Cell number
- Embryos should be 2 to 4 cells at least 48 hours after egg retrieval and preferably about 7 to 10 cells by 72 hours.
- Cell regularity
- The cells within the embryo should be relatively regular in shape and size.
- Higher grade embryos have little or no fragmentation.
Other aspects of the microscopic appearance of the embryos are also noted including the presence of vacuoles, granularity, thickness of the outer shell, etc.
Looking at the embryos under the telescope can give us a reasonable prediction of the chances of success for implantation, there are however no standardized means to measure the quality and it varies from lab to lab.
It is impossible to predict the true genetic potential of the embryo to implant unless we perform a Pre- implantation genetic screening test (PGS) on the embryo.
Our embryologist and reproductive medicine specialist are able to retrieve and fertilize the highest quality embryos because of the state-of-the-art ART labs with Class 10,000 clean room.
Embryo Transfer :
Embryo transfer is the most important step in the IVF procedure, it requires expertise and good skill. Our reproductive medicine specialist has over 35 years of experience in treating patients with infertility.We assure you the highest chance of attaining parenthood.
Depending on the age of the patient 1-3 embryos are transferred into the uterus using special catheters. The embryo transfer is performed under ultrasound guidance from our radiologist. This is a completely painless procedure and does not require any anesthesia.
Two week wait :
After embryo transfer, you will be prescribed medications and a booklet on the do’s and don’ts.
When do I take a pregnancy test?
A pregnancy test should be taken 2 weeks after the embryo transfer. We recommend a beta-HCG blood test as it is more sensitive and accurate when compared to a urine pregnancy test.
What happens to the remaining embryos?
All viable embryos will be frozen.
If embryo transfer was not possible or unsuccessful, then the frozen embryos will be transferred the next cycle.
If implantation is successful, the choice of what happens to the remaining embryos is at your discretion.