Intracytoplasmic Sperm Injection (ICSI)

Most commonly used to treat male infertility, intracytoplasmic sperm injection (ICSI) involves a single sperm being injected directly into an egg and is one of the most important advances in assisted reproductive technology in recent years. Developed in the early 1990s by reproductive medical specialists in Belgium, ICSI is considered a breakthrough in the treatment of male infertility issues. With about 7,000 healthy babies born every year in the United States as a result of ICSI, the procedure offers great hope to couples who are struggling with male factor infertility.

Good candidates for ICSI

Your embryologist may recommend ICSI if he or she has any reason to suspect that achieving fertilization may be difficult. The procedure is most often used by couples who have not been able to conceive due to male infertility factors, including low sperm count, poor sperm motility, poor sperm quality or sperm that cannot penetrate an egg. ICSI is known to be successful in treating these problems, as well as a total lack of sperm as a result of blocked or abnormal ejaculatory ducts, irreparable vasectomy and previous failure with standard in vitro fertilization (IVF).

Procedure

Your ovaries normally release only one mature egg a month, so your doctor will prescribe a fertility drug that you will start taking near the beginning of your menstrual cycle to stimulate your ovaries to produce several more. Once your eggs are mature, your doctor will do an ultrasound to locate them and you will be given an anesthetic so that he or she may collect your eggs using a thin, hollow needle, just as in an IVF procedure.

Around the same time you are undergoing your procedure, your partner will provide your doctor with a semen sample. If there is not enough sperm in his sample, he will be given an anesthetic and undergo a procedure called percutaneous epididymal sperm aspiration, in which your doctor will retrieve his sperm from one of his testicles with a needle. And if an adequate amount of sperm hasn't been collected following this procedure, your doctor will take a biopsy of your partner's testicular tissue, which may have sperm attached to it.

Once your eggs and your partner's sperm are collected, a single egg will be held in a specialized pipette (a microscopic eye-dropper) and your doctor will gently pick up and immobilize a single sperm with a very delicate, sharp and hollow needle. The needle will then be carefully inserted through the shell of the egg and the single sperm will be injected before the needle is carefully removed. The procedure is then repeated on any additional mature eggs. Each microfertilization takes less than ten minutes and does not harm the egg or the sperm in any way.

Two days later, your doctor will check your eggs to see if they have undergone fertilization. If so, two or three of your fertilized eggs, which are now called embryos, will be transferred to your uterus through your cervix using a thin catheter. You will be able to go home the same day. If ICSI is successful, an embryo will implant itself in your uterine wall and grow into a baby. About one third of ICSI pregnancies are multiple pregnancies. In about two weeks, a pregnancy test will be able to tell you if the procedure was a success.

One cycle of ICSI, from the time you start taking medication to the transfer of the eggs and sperm, can take anywhere from four to six weeks to complete. This includes waiting for your eggs to mature, having your eggs and your partner's sperm retrieved and the transfer of embryos to your uterus.

Advantages

The greatest advantage of ICSI is that it gives couples with male factor fertility a chance to conceive a child who is genetically related to both partners. It also eliminates the chance of fertilization problems because your doctor conducts and carefully monitors the process outside your body. Furthermore, research has recently shown that fertility drugs do not increase your chances of developing ovarian cancer, even when taken for more than a year.

Disadvantages

Many of the risks related to ICSI are the same as for IVF, which is known to increase the risks of ovarian hyperstimulation syndrome (OHSS), a condition that sometimes occurs as a result of taking fertility drugs, and multiple pregnancy, which occurs in 30 percent of IVF-related procedures. While you may be happy to have more than one baby, the risk of miscarriage and other complications are significantly increased in such cases.

Other disadvantages include an increased risk of ectopic pregnancy, in which case an embryo drifts up to your fallopian tubes or abdominal cavity and implants there instead of in your uterus. Additionally, in cases of severe male infertility problems, the genetic cause of your partner's infertility may be passed on to the child. However, because most ICSI babies worldwide have not yet reached an age to reproduce, more research needs to

be done before any formal conclusions can be made about these risks. There have been recent concerns that ICSI may carry an increased rate of birth defects. While previous studies did not find any differences between ICSI and non-ICSI babies, a recent, larger study published in Reproductive Biomedicine Online found that, overall, major problems that impact quality of life and need medical attention affected 8.6 percent of ICSI babies, versus 6.9 percent of babies conceived naturally. The most common problems were heart and internal urinary/genital defects, both of which increased by 1 percent more than normal in ICSI babies.

Success Rates

According to the American Society for Reproductive Medicine, fertilization occurs in 50 to 80 percent of injected eggs. Approximately 30 percent of all ICSI cycles performed in the United States in 1998 resulted in a live birth, which is comparable to rates seen with IVF. In addition, younger couples may achieve even more favorable results. Factors such as poor egg quality and advanced maternal age may result in lower rates of success.

Cost

In the United States, one cycle of ICSI can cost anywhere from $10,000 to $15,000. The price varies depending on where you live, your medications, and the number of cycles you undergo. Many insurance companies do not cover the cost of fertility procedures, but financing plans may be available through your doctor.