ICSI stands for Intracytoplasmic Sperm Injection. It’s an assisted reproductive technique used in cases of male infertility or when there are issues with sperm quality or quantity. During ICSI, a single sperm is directly injected into an egg to facilitate fertilization. This procedure is often performed as part of in vitro fertilization (IVF) to increase the chances of successful fertilization when conventional methods might not be effective.

Preliminary Steps of ICSI

Prior to commencing the ICSI procedure, a comprehensive physical examination is conducted by the obstetrician to evaluate the prospective mother’s health. This includes a blood test around the 2nd or 3rd day of the menstrual cycle to assess ovarian functions. An ultrasound examination is performed to determine the number of eggs in each cycle and calculate the required hormone dosage for ovarian stimulation, factoring in age, physical health, and examination results.

• Ovarian Stimulation

Upon readiness indicated by the physical examination, the obstetrician initiates ovulation induction. Hormonal injections are administered daily to stimulate multiple egg growth and maturation, typically culminating in full egg maturity 8-14 days post the initial hormone injection.

• Monitoring Egg Development

Transvaginal ultrasounds are periodically conducted to track egg growth and follicular expansion. Hormones are then injected to promote oocyte maturation, preparing for egg retrieval in approximately 34-36 hours.

• Egg Retrieval

Under light sedation, the obstetrician retrieves the eggs using a thin needle guided by ultrasound. The targeted egg follicles are punctured to collect eggs, subsequently transferred to an egg culture medium until readiness for fertilization. The retrieval process usually spans 20-30 minutes.

Sperm Collection

Simultaneously with egg retrieval, the male partner undergoes sperm collection. Alternatively, sperm can be collected earlier and frozen. Best results are advised by refraining from ejaculation for 2-3 days before collection. The collected ejaculate undergoes semen analysis within an hour. The embryologist selects the healthiest, most mobile sperm, nurturing them before injection into the egg for fertilization.

For male-factor infertility cases involving complete absence of sperm, procedures like Percutaneous Epididymal Sperm Aspiration/Testicular Sperm Extraction (PESA/TESE) are performed by a urologist. This method retrieves sperm from the testicle for injection into the egg, facilitating fertilization, particularly beneficial when weak or unhealthy sperm cannot naturally penetrate the egg’s outer shell.

Process During ICSI

ICSI Fertilization: An embryologist carefully selects healthy, mature eggs and situates them on a laboratory dish. Using a fine glass needle, a single robust sperm is collected and injected into the egg, facilitating fertilization.

Embryo Cultivation: Following successful fertilization, the embryologist oversees the embryo’s cultivation for a span of 3-5 days. Monitoring begins from single-cell division, progressing through various stages such as 2 cells, 4 cells, 8 cells, 32 cells, culminating in over 100 cells forming a compacted stage embryo. This development continues until the embryo reaches the blastocyst stage on the fifth day post-fertilization.

Embryo culture takes place in a specialized nutrient solution within the controlled laboratory environment, maintaining conditions akin to those within the mother’s womb. This environment aids optimal embryo growth, leading to subsequent grading and transfer procedures.

Post-ICSI Procedures

There are two types of embryo transfer:

• Fresh Embryo Transfer (ET): Conducted during the same cycle as induction-ovulation. Typically performed 5-6 days post-egg retrieval, once the embryo has reached the blastocyst stage. The embryo’s optimal growth and the mother’s readiness for pregnancy are crucial. The fertility doctor uses ultrasound guidance to safely place the embryo into the uterine cavity for implantation.
• Frozen Embryo Transfer (FET): Occurs in a subsequent ovulation cycle to avoid potential side effects. The embryo is frozen and thawed when the mother’s physical condition aligns for the transfer in the following cycle.

Pregnancy Test

Approximately ten days after the embryo transfer, a pregnancy test is scheduled by the fertility doctor. This involves a blood test to measure beta-HCG hormone levels and assess pregnancy. Upon confirmation, standard antenatal care commences. Subsequent appointments monitor the mother-to-be’s health, including ultrasounds to track fetal development at regular intervals

Embarking on the journey of fertility treatment often involves multifaceted procedures and considerations. ICSI, with its precise techniques and tailored approach, addresses a spectrum of infertility issues, presenting hope to those facing obstacles in conceiving naturally. From meticulous evaluations and ovarian stimulation to embryo cultivation and transfer, each stage plays a pivotal role in the potential success of ICSI. As advancements continue to refine this assisted reproductive technology, understanding its nuances becomes paramount, guiding individuals towards informed decisions and the prospect of fulfilling their aspirations for a family.