What is Intracytoplasmic Sperm Injection?

Intracytoplasmic Sperm Injection (ICSI) is an assisted fertilisation technique in which a single sperm is injected directly into an egg to guarantee fertilisation. It is an ideal treatment for couples in which the male partner has fertility problems, or where disability, disease, or a vasectomy prevents normal delivery of sperm.

The technique is used in conjunction with the IVF procedure, with the fertilised eggs matured to the 6 to 8 cell, or blastocyst, stage before they are implanted back into the uterus.

This article is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites. 

Who can benefit from ICSI? 

ICSI can help overcome many of the problems of male infertility, including:

• Low sperm count, including total absence of sperm in the ejaculate
• Low sperm mobility
• High levels of abnormal sperm
• Absence of sperm due to an obstruction, problems with the vas deferens, or a failed vasectomy reversal
• High levels of anti sperm agents in the semen or cervix
• Ejaculation problems, including retrograde ejaculation

The success rate for the procedure will depend on the nature of the original issue. Fertilisation rates are high at around 60% - 70%, however, the success rate after implantation remains the same as standard IVF at 20%-30%. Thus the overall success rate is reduced.

ICSI can be used in conjunction with frozen eggs and/or sperm, and is often considered by patients diagnosed with testicular cancer who will freeze their sperm for later use in the technique. 

The ICSI Procedure 

ICSI is an extension of the standard IVF procedure, and includes the following stages:

• Chemical stimulation of the ovaries to produce multiple eggs
• Collection of these eggs trans-vaginally using a catheter
• Preparation of eggs and sperm for maximum effectiveness
• Injection of a selected sperm directly into the egg
• Development of the fertilised egg to the 6-8 cell, or blastocyst, stage
• Implanting of up to 3 embryos directly back into the uterus

The way in which the sperm is collected will depend on the problem involved:

• For low sperm count and low mobility sperm, the male partner will produce a sample when required
• Where sperm is absent in the ejaculate, it may be taken directly from the testes or epididymis via a biopsy under general anaesthetic
• If ejaculatory dysfunction occurs due to disability or injury, a sample may be produced via electro-ejaculation
• In the case of retrograde ejaculation, sperm may be recovered from the urine

Possible Complications

The main concern with ICSI, is the selection of sperm. In nature, the strongest and healthiest sperm will be the most successful in reaching the egg first, ensuring the best possible communication of genetic material. However, in this technique, the sperm is selected in the laboratory and may not be the strongest. This is particularly the case where there is limited choice due to a low sperm count or a high proportion of morphologically abnormal sperm. The risks of passing on congenital defects are therefore higher than with normal conception, and patients may wish to consider pre-implantation genetic diagnosis (PGD) to screen for these before they proceed.

A further factor to consider is that if the father’s fertility problems are genetic, then there is a high risk of passing this on to the child. 

As the procedure is done as part of the IVF cycle, the same risks also apply, including multiple births, problems with over-stimulation of the ovaries, and an increased risk of ectopic pregnancy.

Costs 

The costs of ICSI undertaken privately will add up to £1,000 to the cost of IVF treatment (which are between £1,000 and £4,000 per cycle, depending on the clinic involved). The method of sperm retrieval will also affect the overall cost, especially where direct extraction from the testes is involved.

There may be the opportunity to have ICSI as part of IVF treatment on the NHS, but this varies between local health authorities, and will depend on the age and circumstances of the prospective patient.

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