If your pregnancy delay is a result of male fertility problems, such as a low sperm count, or sperm that can’t penetrate the egg, IVF alone unlikely to help. This is where Intra Cytoplasmic Sperm Injection (ICSI) is most appropriate. ICSI is also useful if you’ve had a vasectomy but now want to have children.
At Virtus Health, it is our policy to encourage the use of standard IVF rather than ICSI unless there is a specific indication for ICSI.
- What is ICSI?
ICSI can be part of your IVF treatment cycle. The major difference with ICSI is how we achieve fertilisation: using very fine micromanipulation equipment, we inject a single sperm into each egg. During ICSI, sperm are selected for injection on the basis of their shape (morphology) and motility.
ICSI is often recommended when there are no sperm in the semen, and we have to obtain them surgically from the testes.
What is the ICSI process?
The ICSI process is an extra step that is used in an IVF treatment cycle. First, your ovaries are stimulated using a series of hormone injections, to encourage the growth of multiple eggs. Once the optimal number of follicles have developed, you will be given an injection to trigger ovulation, and the eggs contained within the follicles will then be collected in a day surgery procedure.
However, instead of the eggs being then placed together in a dish with your partner's or a donor's sperm (standard IVF), a highly skilled embryologist will perform ICSI, which involves injecting a single sperm into each egg using very fine micromanipulation equipment to achieve fertilisation.
So what is ICSI and who's it suitable for?
Welcome to Fertile Minds. I'm Dr. Ben Kroon, fertility specialist reproductive endocrinologist, obstetrician and gynaecologist with Queensland Fertility Group. And today I'll be explaining intracytoplasmic sperm injection or ICSI.
So what is ICSI and why would you use ICSI? ICSI is very different to standard IVF. So with standard IVF, all the sperm are essentially put in a little dish with a bunch of eggs, multiple sperm are put in that dish. And the idea is that it's left overnight to try to fertilise. And in the morning you find out how many of those eggs are fertilised.
Now with ICSI, it's quite different. So with ICSI, the shell around the the outside of the eggs and some of the cells around the outside of the egg are separated, the egg is checked to make sure it's mature, and then the sperm is immobilised and then sucked up into a very fine micro pipette before it's injected into the egg. And hopefully fertilisation occurs.
Both of them, the fertilisation is checked in the morning. Now, when you hear that, you think, hey, listen shouldn't everyone be using ICSI? Why wouldn't everybody decide to have their eggs injected? Well, it's not quite that simple, ICSI isn't for everybody.
The success rates are basically the same. So whether you use IVF or whether you use ICSI you're not actually gonna get better success rates overall. Fertilisation is about 60 to 70%, regardless of what type of fertilisation method that you use. Obviously, if in general terms it's better to have hands off the, hands off the eggs. You know, we would tend not to want to manipulate eggs and manipulate sperm if we didn't need to but in the circumstances where the sperm is poor, for example, if there are sperm antibodies in people, you know, a bloke who maybe has had a vasectomy before or when the sperm count is very low, when it's not moving well or when the morphology, what it looks like, it's highly abnormal - in those circumstances, when we're your fertility specialist is anticipating that fertilisation won't be easy, that's when it's ideal to be able to select the sperm and inject them into the egg using ICSI.
Now, sometimes people have an IVF cycle and they use standard IVF, which to be honest, if, if the sperm's normal, that's what I'd recommend. And they discovered that the next day, no, no fertilisation has taken place. Now in those circumstances, obviously that's a very upsetting thing that does tell us a lot about maybe the reason why a couple's not conceiving, but we know that if that happens we can very easily get around that using ICSI next time around in most circumstances.
So it's very highly, highly effective treatment for many forms of male factor infertility. So one of the interesting things about ICSI is that it's such an effective treatment for male factor infertility, that it's actually meant that while we investigate male factor infertility there's many things that we still don't know about, about sperm and the reasons why sperm doesn't fertilise an individual egg or a person's eggs because this particular treatment is so successful at getting around those problems.
One of the questions that people often ask is, is it a problem to use ICSI? And it's not a problem to use ICSI, but in general terms we prefer to have our hands off the eggs and sperm. If we can, the less your eggs and sperm are manipulated the better - that's my view, at least. But certainly if the, if the sperm is poor in some way then, then ICSI is definitely the way to go.
One of the questions has been does it alter a baby's development? Are there more abnormalities after using ICSI for fertilisation? And interestingly, the studies do suggest that there is a slight increased risk of abnormalities in babies born after ICSI compared with standard IVF. But what is hard about those studies is that if you look at the groups of people that need standard IVF versus ICSI, there are actually people who have more I guess, genetic abnormalities, they might have disorders of the Y chromosome where in fact sperm production is very poor, or they might have other genetic issues, cystic fibrosis, or other types of genetic issues where in fact using ICSI is required.
So the question is, is it actually the ICSI itself or is it the group of people who need ICSI that might actually have a slightly higher rate of abnormalities that they're born with? So it's quite hard to know whether or not this whether ICSI itself is actually, whether there a high rate of abnormalities actually attributed to ICSI process or was it just the group of people who over a whole population find that they need ICSI. So I guess an answer to that question, you know, when I'm talking to patients, I'd say I wouldn't use ICSI upfront if everything was fine but if there is a problem with a sperm I'd have absolutely no hesitation using it. It's very effective, highly effective, and very safe.
A couple of other situations where people might consider using ICSI over something like IVF is the very specific situation where we have frozen eggs. So with eggs that have been frozen because of cancer treatment, or because a woman's frozen her eggs for other reasons beforehand, in fact, the shell so to speak of that egg is hard to get into. And that needs to be a situation where the sperm is actually injected into and otherwise fertilisation is very poor.
Another time when you do need to use ICSI is when sperm is retrieved from the testicles. So sometimes blokes have got no sperm or azoospermia. And in that circumstance, often the sperm is retrieved from the testicles using a needle biopsy. And when that happens, that sperm is not swimming, it's just twitching. And there's no way that it could possibly fertilise an egg without actually being injected. So in that case, 100% of the time ICSI is required to take that sperm, which is very poorly moving. And the numbers are usually very low to inject those into the egg.
The final reason that I was just thinking about that is I guess of interest to a lot of people, because it's quite topical is pre-implantation genetic screening. So for pre-implantation genetic screening which you'll hear about elsewhere, pre-implantation genetic screening is where an embryo is screened for its genetics. And in that circumstance, you can fertilise the eggs by standard IVF, but the genetic screening is ever so slightly more accurate when, when the sperm is actually injected into the egg just because in the situation where IVF is used, some of the sperm DNA can be found on the outside of the egg. And that may have a very small chance of altering the accuracy of the, the pre-implantation genetic screening test.
All right, everybody, I hope you found this video helpful. Please leave a comment below and make sure you subscribe to our channel to receive more videos about fertility and fertility treatment. Thanks so much.
*All opinions expressed on the Fertile Minds YouTube Channel belong to the individual doctors, scientists and specialists, not the Virtus Health group.
- What is PICSI (ICSI-HA)?
PICSI (sometimes also referred to as ICSI-HA) is a process that is used to select sperm for ICSI. The selection of sperm is based upon those that are able to bind to a hyaluronan hydrogel, mimicking the natural binding of mature sperm to eggs in the female.
- What is the PICSI process?
PICSI involves the use of a special sterile culture dish with three microdots of hyaluronan attached to its lower interior surface. The dish is used as an additional step in the selection of sperm at the time of the ICSI (micro-injection) procedure. A suspension of prepared sperm is added to the microdots and within a few minutes, motile sperm will bind to the hyaluronan. It should however be noted that for the sperm to bind to the hyaluronan they must be progressively motile and therefore patients using testicular or non-motile sperm cannot use PICSI.
- Who might benefit from the use of PICSI?
Research indicates the following patient groups may benefit from the use of PICSI:
- Poor fertilisation in previous ICSI cycle
- Poor embryo development in previous ICSI attempts
- High levels of sperm DNA damage (identified from SCSA testing)
- Reduced sperm morphology
- Reduced sperm motility
- How much does ICSI cost?
ICSI is used in conjunction with an IVF cycle and has a cost of approximately $300-$400 (after Medicare rebates have been claimed).
Our nurses and administrative staff are experts in explaining all of the costs involved and navigating the Medicare Safety Net scheme and can also provide you with current costs. If you have any questions regarding ICSI costs, please call 1800 111 483 or send us an email.
- Download IVF & ICSI booklet
For more information about ICSI, visit our Patient Information Booklets page. This booklet talks about the stages of IVF and ICSI treatment, what to expect from treatment, and gives advice on how to cope with the stress of IVF and ICSI treatment.
To find out more about ICSI or PICSI, or to book an appointment with a Queensland Fertility Group Fertility Specialist, call 1800 111 483 to speak with an experienced fertility consultant.