intra cytoplasmic sperm injection(ICSI)

ICSI (Intra Cytoplasmic Sperm Injection)

Photo of equipment used for ICSIIf there is a question of the sperm's ability to fertilize the egg, due to either a low sperm count or poor quality of the sperm, that poses no problem whatsoever. Intra-Cytoplasmic Sperm Injection (ICSI) would be performed instead of regular In Vitro Fertilization (IVF). With ICSI, the eggs are retrieved the same as if you were doing conventional IVF. However, the eggs and the sperm are then fertilized in the laboratory, by direct injection of a single sperm into each egg. Three days later the resulting embryos are simply placed into your uterus with no surgery, just as with IVF. Extra embryos are frozen for later attempts at pregnancy.

The availability of this Intra-Cytoplasmic Sperm Injection, "ICSI" technique (which was developed and perfected by the Brussels University and our institution in St. Louis) means that men whose sperm previously were too weak or too few to fertilize in vitro (IVF), now have no problem fertilizing their wife's eggs. The fertilization rate per egg using ICSI is about 70% despite the sperm being terrible, the fertilization rate per infertile couple is over 99% if the wife has adequate eggs, and the pregnancy rate per treatment cycle is over 50%. This is not significantly different from regular IVF with normal sperm. This technique is very cost-effective, and will give you the same high chance for getting pregnant as any couple with normal sperm.
Photo of ICSI procedureHow Does ICSI Work?

My colleagues, Drs. Van Steirteghem and Devroey from the Free University in Brussels, and I showed how we can take a single, almost non-moving "dead" appearing sperm and inject it into a woman's egg, getting a normal embryo and a completely normal baby. So far, over 10,000 babies have been born with this new technique from men who were otherwise considered hopelessly sterile. The babies are physically, mentally, and genetically completely normal, no matter how poor or miserable the sperm of the father.

We can take a man who would otherwise have to resort to donor sperm, and if we can find just a few weak sperm in his otherwise sterile appearing ejaculate, it is more than enough to microsurgically inject these few sperm into his wife's eggs, fertilize them normally, and get her pregnant.

If there is absolutely no sperm in the ejaculate, we can perform a testicle biopsy, remove the few non-moving sperm that we find through a highly refined ultra micropipette, inject it into the wife's egg and still get her pregnant. Even in testicles where allegedly there is no sperm production, we can usually (but not always) find a few sperm, which is enough for successful ICSI.

1: Immobilizing the sperm's tail before picking it up.
Immobilizing the sperm's tail before picking it up.
2: Injection of sperm into the egg. Figure 2:
Injection of sperm into the egg.
3: Fertilized egg demonstrating the two nuclei – one from the father, one from the mother.
Fertilized egg demonstrating the two nuclei – one from the father, one from the mother.

see the video to see how it works




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