ICSI: Procedure, Effectiveness and Risks

Lab technician performing ICSI procedure.

What Is ICSI?

ICSI, or intracytoplasmic sperm injection, is the injection of one live sperm directly into a woman’s eggs. This procedure is a form of in vitro fertilization (IVF) used to assist couples experiencing extreme complications due to male infertility, or those who have had no success after previous attempts with IVF.

ICSI circumvents many of the obstacles to fertilization, and is a technique that offers couples a path to successful pregnancy who would have little hope otherwise.

What Happens During The ICSI Procedure?

To begin with, a number of mature eggs will need to be produced. To ensure this, the woman will be required to receive ovarian stimulation combined with the use of fertility drugs.

Later, the eggs are removed through the vagina using vaginal ultrasound and placed in incubation under carefully controlled conditions.

After a semen sample is obtained, the live sperm cells are then separated from the semen by centrifuging, which is done by spinning the sample in a special machine. Using a tiny glass needle (called a micropipette), the embryologist then takes one live sperm and injects it directly into an egg.

The fertilized egg (embryo) is then allowed to develop in the lab for about 1-5 days before being transferred to the woman’s uterus.

Who Is ICSI For?

ICSI is a method that helps overcome a number of complications with fertility, including:

  • The male partner does not produce enough sperm for successful artificial insemination or IVF.
  • Abnormal sperm motility.
  • Unexplained infertility.
  • Inability of the sperm to attach to an egg.
  • No sperm in the semen due to a blockage in the male reproductive tract (obstructive azoospermia).
  • When traditional IVF has not been successful, even with normal sperm.
  • Eggs used that were matured in vitro.
  • Eggs used that were previously frozen.

In situations where both male factor infertility and abnormal semen analysis are an issue, ICSI would almost certainly be necessary. ICSI may also be necessary for men who have undergone a vasectomy reversal, even if the sperm are otherwise healthy. This is because of the potential presence of sperm antibodies that could adversely affect fertilization.

​Some couples opt to use ICSI even if is not necessarily indicated, in order to have the greatest chances of success. However, if the sperm are within normal parameters, a standard IVF procedure can achieve maximum fertilization without the need for ICSI.

How Effective Is ICSI?

Many couples who have had difficulty because of male fertility problems have had successful pregnancies by undergoing the ICSI procedure. Through ICSI, 70-80% percent of all eggs injected become fertilized, which is the same rate as when no male fertility issues are present.

Additionally, these fertility rates are comparable to those achieved by couples using IVF without male fertility issues.

Problems That Could Occur

The following issues may occur during or after the ICSI procedure:

  • Damage could occur to some or all of the eggs.
  • The egg may fail to develop into an embryo.
  • It is possible for the embryo to stop developing (embryonic arrest).

When fertilization is successful, the chances of a couple having one baby, twins or triplets is the same regardless of whether they undergo in vitro fertilization with ICSI or not.

Does ICSI Increase The Risk For Birth Defects?

With natural pregnancy, there is about a 1-3% chance of a baby being born with a major birth defect . Although the odds for birth defects associated with ICSI are comparable to that of standard IVF, they are still slightly higher when compared to natural conception.

It could be that the infertility itself may be responsible for the slightly higher birth defect risk, not the procedure.

Some conditions, such Angelman syndrome Beckwith-Wisemann syndrome, hypospadias and sex chromosome abnormalities, have been linked to ICSI. It’s important to note that sex chromosome abnormalities are associate with the following problems:

  • A greater chance of miscarriage occurring.
  • Heart conditions affecting infants that may require surgery.
  • Greater risk for childhood learning disabilities or behavioral problems.
  • Greater risk for infertility when the child becomes an adult.

These conditions are believed to occur in less than .08% of children who were conceived with this technique. However, this is still a higher rate than is seen with natural conception. It is currently not known why this risk is higher.

While ICSI does not increase the risk of Down’s syndrome, it does increase with maternal age. Additionally, while there has been research looking into the question of developmental delays in ICSI-born children, there is not enough evidence to indicate that this is true.

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