In Vitro Fertilisation with ICSI is an assisted reproduction procedure in which a single sperm cell is injected by micro-injection directly into an egg. Once fertilised, the egg becomes a pre-embryo and is transferred into the uterus to continue its development.
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This technique involves the insemination of an egg by a sperm microinjection. The steps before and after insemination are exactly as in a classical IVF without ICSI, the only change is the insemination technique. To perform ICSI only one sperm is needed per egg, while in a classic IVF without ICSI between 50,000 and 100,000 are needed. Once fertilised, the egg becomes a pre-embryo and is transferred to the uterus to continue development.
ICSI was developed in 1992 to treat cases of male infertility or abnormalities in the sperm: azoospermia (no sperm), oligozoospermia (low concentration of sperm), asthenozoospermia (low motility) or teratozoospermia (poor sperm morphology) and since then there have been major advances made in the treatment of infertility of male origin. Today it is routinely used. Here at Eugin Clinic, we practice ICSI in 99% of cases, unless otherwise indicated.
1. Monitoring and stimulating the ovaries
The ovaries are stimulated by administering hormones (FSH, Follicle Stimulating Hormone and in some cases, Luteinising Hormone, LH) and the cycle is monitored using scans until the follicles reach the correct number and size (only one follicle is needed for this technique). At this point, another hormone is administered that imitates LH, the hormone that naturally triggers ovulation (LH or Luteinizing Hormone), and this results in an egg being released.
2. Egg harvesting and in vitro fertilisation
Harvesting the eggs is done by inserting a needle into an ovarian follicle and aspirating it. The procedure is done while the woman is under sedation. Once they have been removed, the eggs are stored in a culture dish while the semen is prepared to separate out the motile sperm. Then the eggs are denuded, which means that the cells on the surface are removed, and a single sperm is injected into each one.
The day after harvesting and the ICSI procedure we will know how many eggs have been fertilised. Over the next 2 or 3 days, these fertilised eggs become pre-embryos ready to be transferred to the uterus.
On transfer day, the pre-embryos showing the best signs of developing are selected. The law permits us to transfer up to 3 pre-embryos, but the average number is 2.
The pre-embryos are placed in a thin catheter and the gynaecologist inserts the eggs deep inside the uterus. No anaesthetic is required for this procedure. Of the transferred pre-embryos, normally only one will implant, but bear in mind that sometimes more than one may implant, resulting in multiple pregnancy.
The pre-embryos that have not been transferred are frozen in liquid nitrogen (this type of cryopreservation is known as Vitrification) and they are then carefully labelled and stored in the embryo bank. These pre-embryos can be used in subsequent cycles if a pregnancy is not achieved on the first attempt. Evidently, the treatment for preparing the uterus for the transfer of frozen embryos is much simpler as there is no need to stimulate the follicles and harvest the eggs.
Last Updated: February 2018