IVF - ICSI, Intracytoplasmic Sperm Injection
During ICSI just one sperm is injected directly into the egg cytoplasm using a micromanipulative apparatus that transforms imperfect hand movements into fine and precise movements of micromanipulation tools.
Intracytoplasmic Sperm Injection (ICSI) is an assisted reproductive technique (ART) initially developed by Dr. Gianpiero D. Palermo in 1993 to treat male infertility. It is most commonly used in conjunction with in vitro fertilization (IVF). Following IVF procedure, the physician places the fertilized egg into the female’s uterus for implantation. Sperm are obtained by the same methods as with IVF: either through masturbation, by using a collection condom, or by surgically removing sperm from a testicle through a small incision (MESA, TESE). The females are treated with fertility medications for approximately two weeks prior to oocyte retrieval to stimulate superovulation, where the ovaries produce multiple oocytes rather than the normal one oocyte. The oocytes are retrieved by either laparoscopy, or more commonly, transvaginal oocyte retrieval. In the latter procedure, the physician inserts a thin needle through the cervix, guided by a sonogram and pierces the vaginal wall and then the ovaries to extract several mature ova. Before the embryologist can inject the sperm into the oocyte, the sperm must be prepared by washing and exposing it to various chemicals to slow the sperm movement and prevent it from sticking to the injection plate. Also, the oocytes are treated with hyaluronidase to single out the oocyte ready for fertilization by the presence of the first polar body. Then, one prepared sperm is injected into an oocyte with a thin needle. Often, embryologists try to fertilize several eggs so they can implant more than one into the uterus and increase the chance of at least one successful pregnancy. This also allows them to save extra embryos, using cryopreservation, in case later IVF rounds are needed.
After the embryologist manually fertilizes the oocytes, they are incubated for sixteen to eighteen hours and develop into a pronucleate eggs (successfully fertilized eggs about to divide into an embryo). The egg then grows for one to five days in the laboratory before the physician places it in the female’s uterus for implantation.
The chance of fertilization increases dramatically with ICSI compared to simply mixing the oocytes and sperm in a Petri dish and waiting for fertilization to occur unaided (classical IVF procedure). Studies have shown that successful fertilizations occur 50% to 80% of the time. Since the introduction of ICSI, intrauterine insemination (IUI) has decreased in popularity by 80%.
ICSI is more effective method than spontaneous fertilization. In many centres it is preferred to minimize the risk of “zero fertilization” which is frequent even in normospermic men.
This method is very successful mainly in the following cases:
In these situations, suboptimal spermatozoa could by-pass the physiological check-points of natural fertilization and generate embryos, and subsequently babies. Conventional ICSI has the hypothetical risk of injecting immature, DNA damaged, aneuploid, low motile, morphologically abnormal, zona binding deficient, poor acrosome reacted, spermatozoa. Nowadays, we have no real knowledge of the effects of suboptimal sperm selection on ICSI adults in the long term, at least for humans. A potentially worrying aspect of the injection of DNA damaged spermatozoa for example, has been suggested by studies performed on animals which showed not only a negative effect on pregnancy and birth, but also later side effects on the health of adult animals such as aberrant growth, premature ageing, abnormal behaviour, and mesenchymal tumours.
The recent refinements of the ICSI procedure are reliable, easy-to do, non-invasive and in some cases “closest to the nature” than the conventional procedure. For example, selecting spermatozoa prior to ICSI by their maturation markers such as HAZP receptors it is possible at very least to mimic nature in order to restore physiological selection and prevent hypothetical fertilization by DNA damaged and chromosomal unbalanced spermatozoa. In addition, non-invasive imaging sperm selection techniques such as IMSI or sperm head birefringence can be valid tools for helping in selection of the ideal spermatozoa. In fact, sperm selection based on non invasive morphology or maturity markers helps the embryologist in selection of the “ideal” spermatozoa to inject. These new advances in ICSI may allow the selection of the spermatozoa contributing to improve: fertilization, embryo quality, blastocyst formation, pregnancy rate and reduction in abortion.
Sperm fragmentation test is genetic selection. A sperm DNA fragmentation test can tell you whether there’s any DNA damage to be found among your partner’s sperm.
With the fragmentation test, you can look at the cells themselves to determine what percentage of sperm have fragmentation, which basically means “damage.” Less than 15 percent damage usually means a very good outcome, while 16 to 29 percent can mean a less rosy outlook, though still pretty good. If more than 30 percent of the sperm show fragmentation, it may prove very difficult to get and maintain a healthy pregnancy, even if you are doing IVF.
DNA damage can increase with age, so a man in his 50s or 60s may have a higher percentage of sperm fragmentation. Other factors — such as exposure to various chemicals or toxic agents, excessive heat, chronic infections in the prostate, chemotherapy, radiation or smoking — can also be to blame. On the positive side, there’s some hope that antioxidant vitamins can help minimize the damage.
This test is not for direct use the sperm, and ICSI. Sperm for fertilization are already unusable. It does not help to improve embryonic development.
Methods for improving the outcome of ICSI:
This method is suitable for everyone but we highly recommend it especially in the following cases:
– previous total failure or low fertilization even after ICSI
– low embryo quality or their failure to develop
– repeated abortions
ICSI safe and effective therapy for male factor infertility, but may carry an increased risk for the transmission of selected genetic abnormalities to offspring through the increased inherent risk of such abnormalities in parents undergoing the procedure but not due to the procedure itself.
The follow-up studies on ICSI children have demonstrated the safety of this technique although a slight increase of chromosome aberration seems to be caused by the injection of aneuploid spermatozoa.
ICSI offers fertilization and pregnancy rates comparable or higher to that achieved with normal sperm quality for couples who have failed to achieve fertilization on repeated IVF cycles or have severe impairments in semen quality. In addition, the success of ICSI was independent of standard semen parameters (density, motility, and morphology).
A semen pH value outside of the normal range which is harmful to sperm and can cause infertility.
Female disorder in reproductive system at which a woman miss the uterus and thus she is not able to get pregnant and carry a child.
A type of cancerous tumor that develops in the gland cells.
A tumor-forming variant of adenomyosis (endometriosis in the myometrium of the uterus).
Medical condition characterized by the presence of ectopic endometrial tissue within the myometrium.
Failure of the adrenal glands to produce sufficient amounts of hormones.
The absence of a menstrual period in women of reproductive age.
The pathological inability to ejaculate in males, with (orgasmic) or without (anorgasmic) orgasm.
A neurodevelopmental disorder with intellectual and developmental disability, sleep disturbance, seizures, jerky movements and frequent laughter.
A disorder of sex development in which individuals have both testes absent at birth.
An eating disorder characterized by the maintenance of a body weight below average, fear of gaining weight, and a distorted body image.
Failure of the ovaries to release an oocyte over a period of time generally exceeding 3 months.
A condition when immune system mistakenly attacks some of the standard proteins in blood.
A medical condition, where the walls of the uterus stick to one another due to bands of scar tissue.
Male diagnosis connected with male infertility characterised by the complete absence of semen.
The thickening, hardening and loss of elasticity of the walls of arteries.
A condition arising from an abnormal immune response to a normal body part.
A disease in which antibodies against the thyroid gland and its hormone products are produced and destroy the thyroid’s cells and the entire gland.
Complete absence of sperm in the ejaculate of a man.
A noncancerous increase in size of the prostate.
Inborn morphological deviation of the uterus - one of the Müllerian duct anomalies where the uterine cavity is divided in the upper part.
A blockage of both fallopian tubes.
A cancer that develops from breast tissue.
Condition causing cervical mucus too thick and hostile to allow the sperm to penetrate the cervix.
Narrowing of cervix - the opening to the uterus.
A common sexually transmitted disease (STD) caused by the Chlamydia trachomatis bacteria that can lead to serious reproductive morbidity.
A condition in which the vasa deferentia reproductive organs, fail to form properly prior to birth.
Male infertility diagnosis characterized by extremely low concentration of sperm in semen.
A class of sexual disorders defined as the subjective lack of normal ejaculation.
Cancer that arises from the endometrium, the lining of the uterus.
Thickening of the lining of the uterus.
The finger like overgrowths attached to the inner wall of the uterus that extend into the uterine cavity which are made of endometrial tissue
Benign ovarian cysts containing thick, old blood that appears as a brown fluid.
A state in which pieces of the tissue alike to the lining of the uterus (endometrium) grow in other parts of the body.
An inflammation of the inner uterine lining that could interfere with conception and pregnancy outcomes.
An inflammation of epididymis.
The inability (that lasts more than 6 months) to develop or maintain an erection of the penis during sexual activity.
An obstruction prevents the egg or sperm from traveling down the tube, thus making fertilization impossible.
An abnormal growth of fallopian tube tissue.
Persistent, recurrent problems with sexual response, desire, orgasm or pain which may cause fertility problems.
Genetic condition that is the most common inherited cause of intellectual disability, as well as the most frequent cause of autism spectrum disorder.
A sexually transmitted infection which is the most common cause of diseases accompanied by genital ulceration.
Fleshy growths or lumps found around the genitals and anus transmitted through sexual intercourse or during labor.
A group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception.
A rare abnormality of sperm morphology, with the majority of sperm cells being round-headed, which leads to male infertility.
Any congenital developmental disorder of the reproductive system characterized by a progressive loss of germ cells on the developing gonads.
A sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae.
The tumor that arises from the granulosa cells (normally surrounding the oocytes and line the developing follicle) and could impair menstrual periods.
Occlusion of some part of the female genital tract, especially occlusion of the vagina by a thick membrane.
Various types of conditions that can affect the function of the heart or blood vessels, which may have the negative effect also to the infertility
A collection or retention of blood in the uterus, affecting the patient´s fertility.
Hematosalpinx is a medical condition involving bleeding into the fallopian tube.
An infection caused by the hepatitis B virus which inflames the liver and which could also impair sperm motility.
An infection caused by the hepatitis C virus (HCV) that affects the liver and could be transmitted through sexual intercourse by blood or from infecte
A viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS).
A common virus that affects both males and females that could result in genital warts or cancer.
An accumulation of clear fluid in the tunica vaginalis, the most internal of membranes containing a testicle.
A hydrosalpinx is an abnormal pouch containing liquid in a fallopian tube.
A medical condition characterized by excessive levels of androgens in the body.
An excessive amount of estrogenic activity in the body.
Decreased functional activity of the gonads, with retardation sexual development, associated with high levels of hormones that stimulate the gonads.
The condition of elevated concentrations of gonadotropins within the blood.
Excess levels of insulin circulating in the blood relative to the level of glucose and impairing the hormonal levels, even those involved in reproduct
Abnormally elevated levels of any or all lipids in the blood.
The presence of abnormally high levels of prolactin in the blood.
Condition that occurs due to excessive production of thyroid hormone by the thyroid gland.
A medical condition characterized by not enough androgenic activity in the body.
A lower than normal level of estrogen which is the primary sex hormone in women.
A medical term which describes a diminished functional activity of the gonads – the testes and ovaries.
Partial or complete loss of production of one or more of the pituitary gland hormones.
A deficiency in the serum levels of the prolactin hormone.
An anomaly of the penis, with the opening of the urethra located on the underside of the penis, which may lead to infertility.
A condition in which a man has an unusually low ejaculate (or semen) volume.
Group of diseases, which have impact on function of hypothalamus.
A surgery performed to remove a woman's uterus.
A condition in which fertility impairment occurs spontaneously or due to an unknown cause.
A genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete puberty.
The set of symptoms that result from two or more X chromosome in males.
Laurence-Moon syndrome (LMS) is a genetically predisposed disorder affecting both genders.
A presence of more than one million of white blood cells in 1 millimeter (mL) of ejaculate.
Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment.
Collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks normal, healthy tissues.
The luteinisation of ovulatory follicle without a release of an oocyte.
An abnormal condition in a woman's menstrual cycle.
The condition of only one testicle present in the scrotum.
Mumps was a common childhood viral disease caused by the mumps virus. Mumps frequently causes orchitis and impairs male fertility.
Necrospermia is a condition in which spermatozoa in semen are either immobile or dead
Type of cancer arising from the lymphoid tissue.
Complete absence of sperm in the ejaculate due to testicular failure.
A frequent autosomal dominant developmental disorder primarily characterized by short stature, typical facial features and heart defects.
A manifest variant of nutcracker phenomenon, renal vein entrapment syndrome, or mesoaortic compression of the left renal vein.
A disease of excess body fat that can have a negative effect on health, leading to reduced life expectancy and other health problems.
Absence of sperm in the ejaculate despite normal spermatogenesis, caused by an obstruction of the genital tract.
Repetitive nocturnal complete collapses (apneas) or partial collapses (hypopneas) of the upper airway during sleep.
Male fertility diagnosis defined as a combination of low sperm concentration, reduced motility and abnormal sperm morphology in the ejaculate.
Light or infrequent menstrual ﬂow at intervals of 39 days to 6 months or 5–7 cycles in a year.
Semen with a low concentration of sperm and is a common finding in male infertility.
Defect during oocyte maturation.
An inflammation of the testes, involving swelling and heavy pains.
A type of cancer in which abnormal cells begin to grow in one or both of a woman's ovaries.
A clinical symptom complex that can occur in some women undergoing assisted reproductive technologies and that could result in pregnancy complications
Surgical removal of one or both ovaries.
The rare chronic disease typically features a number of small, interlinked abscesses within the pelvis.
A form of abdominal adhesions in the pelvis.
Infection of the upper part of the female reproductive system and a common complication of some sexually transmitted diseases.
An infectious disease caused by the bacterium Mycobacterium tuberculosis and one of cause female infertility.
A pituitary malfunction is a disorder affecting the pituitary gland, either by overproduction or underproduction any of pituitary gland hormones.
An abnormal growth that develops in the pituitary gland that could impair the hormonal balance needed for fertility function.
A condition in which a woman has an imbalance of female sex hormones. This may lead to changes in the menstrual cycle, cysts in the ovaries, trouble g
A condition of abnormally high concentration (more than 250 million / ml ) of sperm in the semen.
A condition of low fertility characterized by low numbers of remaining oocytes in the ovaries or possibly impaired oocyte development or recruitment.
A genetic disorder due to loss of function of specific genes on chromosome 15.
An inflammation of the prostate gland.
A distally blocked Fallopian tube filled with pus.
Three or more consecutive pregnancy losses prior to 20 weeks gestational age from the last menstrual period.
Three or more consecutive pregnancy losses before 20-24 weeks of gestation or below a fetal weight of 500 g.
A kidney cancer that originates in a part of the very small tubes in the kidney that transport waste molecules from the blood to the urine.
The absence of implantation after three or more transfers of high quality embryos or after placement of 10 or more embryos in multiple transfers.
The semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder.
A long-term autoimmune disorder that primarily affects joints.
An acute inflammation of the fallopian tubes.
The absence of any developmental stage of sperm cell in the testes.
An infection of the paranasal sinuses and/or the lungs, associated with several conditions of impaired fertility.
Antibodies that bind to sperm, inhibiting their movement, stopping recognition and entry into the egg.
A rare disorder characterized by a phenotypic female with an XY karyotype.
A sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum.
Teratospermia is a condition characterized by the presence of sperm with abnormal morphology that affects fertility in males.
A medical condition in which the testes diminish in size and may be accompanied by loss of function (production of sperm and testosterone).
Cancer that develops in the testicles.
The inability of the testicles to produce sperm or testosterone.
Cancers that develop within the thyroid gland.
A medical condition impairing the function of the thyroid.
Medical emergency that afflicts the human penis.
A permanent form of female sterilization, in which the fallopian tubes are severed and sealed or "pinched shut", in order to prevent fertilization.
The type of blockage that affects the part of the fallopian tube end towards the ovary.
Turner syndrome is a genetic disorder in which a female is partly or completely missing one X chromosome that results in ovarian dysgenesis.
In the case of cryptorchidism one or both testes are absent from the scrotum. It is is the most common etiologic factor of azoospermy in the adult.
Congenital uterine anomaly (one of the Müllerian duct anomalies) usually associated with communicating or non-communicating rudimentary horn.
A condition of blocked passage through one of the Fallopian tubes.
The most common benign smooth muscle tumors of the uterus encountered in women of reproductive age.
Rare uterine malignant tumour that arises from the smooth muscular part of the uterine wall.
A type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis.
Congenital uterine malformation where both Müllerian ducts develop but fail to fuse, thus the woman has a "double uterus".
A form of a congenital malformation where the uterine cavity is partitioned by a longitudinal septum. It is one of Müllerian duct anomalies.
A form of a congenital malformation where the uterus is partially divided by a longitudinal septum. It is one of Müllerian duct anomalies.
A physical or psychological condition in which woman cannot engage in any form of vaginal penetration.
A disease of the vagina caused by excessive growth of bacteria, with possible detrimental effect on female fertility.
An abnormal enlargement of the pampiniform venous plexus in the scrotum.
The male sex chromosomal disorder characterized by a spectrum of clinical presentations, ranging from ambiguous to normal male genitalia.
A family of genetic disorders caused by missing gene(s) in the Y chromosome.
A rare condition causing chronic lung disease, rhinosinusitis and azoospermia.
A surgical procedure for male sterilization or permanent contraception.
Surgical removal of the uterus.
An infection that primarily affects the parotid glands, caused by the mumps virus which can impair male fertility.
A surgery used to remove part of one ovary or part of both ovaries.