IVF Center of St Louis

Intra Cytoplasmic Sperm Insertion (ICSI) is a procedure by which a single sperm is inserted with the aid of a micro needle into the cytoplasm of a mature oocyte. This procedure is recommended for severe cases of male factor infertility.

The ICSI procedure is conducted as a part of a cycle in which the ovaries of the female partner or egg donor are stimulated with hormones to increase the production of oocytes. Mature oocytes are removed in our office using mild sedation and an ultrasound guided needle. The oocytes are separated and their maturity is assessed in the laboratory. The mature oocytes are injected one by one using a glass holding pipette to secure the egg and a very small micro needle through which the sperm is inserted. The egg is subsequently placed in culture medium and fertilization is determined 12-18 hours later.

Technically, the ICSI technique is a precise and delicate procedure. It requires top quality equipment, well trained and skilled personnel, and attention to detail. In the hands of experienced personnel more than 70% of the oocytes are fertilized with ICSI. Ten percent or less of the injected oocytes are lost in the process of injection, and the pregnancy rates are as good as with standard IVF. As more research is conducted on this technique if is projected that the results are going to improve the outcome of infertility therapy in the future.

Who Needs ICSI

Severe male factor infertility may result from of one or more abnormalities of the several factors evaluated in semen specimens. Among these are: low seminal volume, low motility, low sperm counts or high percentage of abnormal spermatozoa. Other conditions such as failed attempts of fertilization in vitro and immunologic infertility, also warrant the utilization of ICSI. Lack of spermatozoa in the ejaculate due to congenital absence of the vas deferens or blocked vas deferens (vasectomies, infections of the reproductive tract) require PESA/TESA to obtain the sperm which are then used to fertilize the oocytes through ICSI.

The safety of ICSI

It is reassuring to know that more than 50,000 babies have been born in Europe and the USA after ICSI procedures had been employed. These babies have been followed closely and up to now they have not shown a higher incidence of somatic abnormalities than invitro or naturally conceived babies.

However, it has been long suspected that chromosomal abnormalities (Chromosomally Derived Sterility) are implicated in some forms of male infertility. Up to 20% of male infertility can be explained by abnormalities in chromosomes. A review of the literature of somatic chromosome investigations in infertile males has shown that 13.7% of azoospermic males (complete lack of sperm) and 4.6% of oligozoospermic (males with a few sperm) have abnormal chromosomes or karyotype. Therefore, a genetic factor may be affecting gamete formation or function. In normal fertile males the mean frequency of chromosomal abnormalities in spermatozoa is about 10%. Cytogenetic studies in spermatozoa (nonsomatic cell) indicates that advanced age (>40 years) has been associated with structural chromosome abnormalities also in fertile males. The first cytogenetic studies on spermatozoa of infertile males were first published about 2 years ago The results show a highly significant increase (10 fold) in the frequencies of chromosomal abnormalities compared with normal fertile patients.

Infertile couples electing Advanced Reproductive Technologies should be counseled on the cause of their infertility and the "possible genetic" risks when ICSI is performed. If the male partner is a carrier of a constitutional chromosome aberration then the couple may be aware that: in cases of an autosomal structural aberrations the success rate of ICSI is lowered, an increased risk of miscarriage exists and, in ongoing pregnancies in the presence of a chromosome aberration, multiple congenital abnormalities and/or mental retardation are possible: in cases of a sex chromosome aneuploidy. e.g.: 47,XXY or 47,XYY) the success rate is variable, but if successful the risk of aneuploidy in the offspring is probably low or unknown. In cases of structural aberrations of a sex chromosome there is a greater risk of transmitting infertility, depending on the position of the breakpoint.

In some cases of male infertility there may not be major reason for concern about medical conditions being passed on to your offspring. Such is the case of ICSI performed for vasectomy or Immunologic infertility. In other instances, such as in patients with congenital absence of the vas deferens (CAVD) or nonmotile spermatozoa the patient may require further testing and appropriate genetic counseling because those two different scenarios may be indicative of Cystic Fibrosis or Kartagener's Syndrome respectively. Unilateral Absence of the vas deferens and Young's Syndrome are conditions with features similar to CAVD. Whether these patients have an increased risk of having children with these syndromes is not known. Recent research indicates that some seminal traits such as low sperm counts are related to genes located in the Y chromosome. Therefore, chances are that this trait may be passed on to future generations in an unidentified proportion of male offspring.

Collection of sperm for ICSI

Depending on your type of infertility, the sperm may be collected by masturbation or by other conventional means. However, in other cases such as CAVD, vasectomies, or failed vasovasostomies in which there is testicular sperm production but no mechanical ability to ejaculate sperm, other methods may be necessary. Percutaneous Epidydimal (PESA) or Testicular (TESA) Sperm Aspiration accompanied with ICSI have proven to be quite effective in treating these cases of infertility.