What ICSI-IVF Is? Why It’s Done? And Whether It’s Safe BY DR.HEENAAGRAWAL ICSI-IVF is a specialized form of In-Vitro-Fertilization that is used mostly commonly in cases of severe male infertility
after repeated failed fertilization attempts with conventional IVF, or after egg freezing (octet preservation).
It’s also very commonly used for preimplantation genetic testing, or PGT testing. In fact, most clinics require it if you are doing PGT testing. The concept behind this stipulation is that with conventional insemination, all of the sperm attempting to fertilize an egg can potentially fray the lining of the embryo and give inaccurate PGT results.
Pronounced IVF, ICSI stands for intracytoplasmic sperm injection. During regular IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg on its own. With ICSI-IVF, the embryologist takes a single sperm and injects it directly into an egg.
Some IVF specialists recommend ICSI for every IVF cycle. Others reserve the treatment for those with severe male infertility or another medically indicated reason. There are good arguments against the routine use of ICSI. (The risks of ICSI-IVF are below.)
With that said, ICSI-IVF has enabled many infertile couples to get pregnant when, without it, they would not have been able to conceive using their own eggs and sperm.
Why is ICSI-IVF done?
ICSI-IVF is commonly used in cases of severe male infertility, including due to:
- Very low sperm count (also called esoligospermia)
- Abnormally shaped sperm (also called teratozoospermia)
- Poor sperm motility (also known as asthenozoospermia)
If a man has no sperm in his ejaculate but is producing sperm, they can be retrieved through the testes. Sperm extraction or TESE. Sperm obtained through TESE requires the use of ICSI. ICSI is also used in cases. Retrograde ejaculation if sperm is removed from the man’s urine.
Severe male infertility is not the only reason ICSI-IVF is used. Some other evidence-based reasons for ICSI also include:
- Previous IVF cycle had few or no fertilized eggs: Sometimes, a good number of eggs are retrieved, and sperm counts look healthy, but no eggs get fertilized. In this case, during the next IVF cycle, ICSI may berry.
- Frozen sperm are being used: If the thawed sperm don’t appear especially active, ICSI-IVF may be recommended.
- Frozen oocytes are being used: Vitrification of eggs can sometimes cause the hardening of the egg’s shell. This may complicate fertilization, and IVF with ICSI may help overcome this hurdle.
- PGD is being done: PGD (pre implantation genetic diagnosis) is an IVF technologythat allows for genetic screening of embryos. There is concern that regular fertilization techniques may cause sperm cells (who have not fertilized the egg) to “hang around” the embryo, and that this may interfere with accurate PGD results.
- IVM (in vitro maturation) is being used: IVM is an IVF technology where eggs are retrieved from the ovaries before they completely mature. They go through the final stages of maturation in the lab. Some research has found that IVM eggs may not become fertilized by sperm cells at ratescomparableto traditional IVF. More research is needed, but it may be that IVM with ICSI is a good option.
IVF with ICSI can be a great technology when needed. However, there’s some disagreement on when it can and can’t improve success rates. Research is ongoing, but here are some situations that the American Society of Reproductive Medicine reports IVF with ICSI may not be warranted:
- Very few eggs retrieved: The concern is that with so few eggs, why take a risk that they won’t get fertilized? However, research has not found that pregnancy or live birth rates are improved when ICSI is used.
- Unexplained infertility: The logic behind using ICSI to treat unexplained infertility is that since we don’t know what is wrong; treating every possibility is a good plan of action. That said, so far research has not found that ICSI for unexplained infertility significantly improves live birth success rates.
- Advanced maternal age: There’s no current evidence that advanced maternal age impacts fertilization rates. Therefore, ICSI may not be necessary.
- Routine IVF-ICSI (ie, ICSI for everyone): Some reproductive endocrinologists believe that every patient should get ICSI to eliminate the possibility of fertilization failure. However, research has found that for every 33 patients, only one would benefit from the routine use of IVF-ICSI. The rest would be receiving the treatment (and risks) without possible benefit.
ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won’t seem much different than an IVF treatment without ICSI.
As with regular IVF, you’ll take ovarian stimulating drugs, and your IVF specialist doctor will monitor your progress with blood tests and ultrasounds. Once you’ve grown enough good-sized follicles, you’ll have egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle.
Your partner will provide their sperm sample that same day (unless you’re using a sperm donor or previously frozen sperm.)
Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved.
If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval.
You can get more detailed information here in this IVF Treatment Step by Step.
The ICSI procedure costs between Rs. 20,000 to Rs. 30,000. This is on top of the general IVF cost, which on average costs ₹90000 to ₹125000. It may cost more than this if other IVF optionsare being used.
ICSI-IVF comes with all the risks of a regular IVF cycle, but the ICSI procedure does introduce additional ones. A normal pregnancy comes with a 1.5% to 3% risk of major birth defects. ICSI treatment carries a slightly increased risk of birth defects, but it’s still rare.
Some birth defects are more likely to occur with ICSI-IVF, specifically Beckwith-Weidman syndrome, Angel man syndrome, hypospadias, and sex chromosome abnormalities. They occur in less than 1 % of babies conceived using ICSI with IVF.
There is also a slightly increased risk of a male baby having fertility problems in the future. This is because male infertility may be passed on genetically.
These additional risks are why many IVF specialists are saying ICSI should not be used for every IVF cycle. It’s one thing if you need ICSI to conceive. Then, you can discuss with your doctors the pros and cons of using this assisted reproduction technology.
However, if you can have a successful IVF cycle without ICSI, why risk even the slight increase in birth defects?
The ICSI procedure fertilizes 50 to 80 percent of eggs. You might assume all eggs get fertilized with ICSI-IVF, but they don’t. Fertilization isn’t guaranteed even when a sperm is injected into the egg.
Remember that fertilization rates don’t tell you the clinical pregnancy or live birth rates. Once fertilization happens, the success rate for a couple of usingICSI with IVF is the same as a couple using regular IVF treatment.