ICSI (Intracytoplasmic Sperm Injection) is an assisted reproduction technique used as part of an IVF (in vitro fertilisation) treatment. It enables couples in which the man has been diagnosed with fertility issues to have a child of their own. The semen is provided in a sample or a testicular biopsy – if necessary. Embryologists individually select the best sperm, which is subsequently used to fertilise the eggs.
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We always start with an individual assessment of each patient to identify the most suitable fertility treatment, but the following gives an overview of the process that is normally followed.
Ovarian stimulation during an IVF cycle consists of daily injections that stimulate the ovaries to produce more eggs than you would normally. Only a single egg is matured and ovulated each month naturally. By stimulating the ovaries to produce more eggs, a larger number of embryos can be collected.
Depending on the protocol used and how quickly the patient responds, the stimulation phase of the cycle can take between 10 and 20 days. During treatment, 4 ultrasound scans are carried out and a blood test may also be taken to measure the amount of hormones produced by the ovaries. The scans and blood tests monitor how the follicles (fluid filled sacs in which the eggs develop and mature) are growing.
When the ultrasound scans show that the follicles have reached an adequate size and therefore are likely to contain a suitable number of eggs, we schedule the egg collection process. Some 36 hours before the procedure an injection of the hormone hCG is administered. This makes the eggs mature in a similar way to the way they would naturally.
The egg collection is carried out in the operating theatre under sedation and lasts approximately 15 minutes. Once the procedure is completed, you will need to stay in the clinic at least an hour, but you can go home the same day. You’ll need someone to pick you up, and you shouldn’t drive for the rest of the day, because of the anaesthetic.
Once the eggs and the sperm with the best motility and morphology have been selected, and microinjection of the egg can take place. During ICSI, the selected sperm is injected directly into the egg. This gives the best possible chance for successful fertilisation. The embryos obtained are allowed to develop for 5 days in the laboratory before being transferred into the uterus.
The resulting embryos are observed in the laboratory and are classified according to their morphology and their ability to divide. Not every embryo will carry on developing so the decision about when to complete the embryo transfer will depend on the number and quality of your embryos.
The procedure can feel like a smear test. It usually takes around 15 minutes. A tiny drop of culture medium containing one or two embryos is carefully deposited in the uterus using a thin catheter. You will need to have a full bladder for embryo transfer as an abdominal ultrasound scan is carried out during the transfer to ensure the embryo placement within the uterus is optimised.
At IVI we recommend single embryo transfer (SET). Studies show that multiple pregnancies carry a much greater risk of low birth weight, perinatal and infant mortality, preterm delivery and disability. If you have high-quality embryos, choosing to transfer more than one embryo does not increase the chances of becoming pregnant, only the chances of having a multiple pregnancies and its associated risks.
Once the embryo transfer has been made, we vitrify the remaining good quality embryos so that they can be used in a later cycle without the need for further ovarian stimulation.