ICSI: Intracytoplasmic Sperm Injection With IVF

ICSI key concepts

• Intracytoplasmic sperm injection (ICSI) involves injecting a single sperm directly into an egg’s cytoplasm to achieve fertilization during the in vitro fertilization (IVF) process.
• It is a highly specialized procedure to help overcome male infertility issues, such as low sperm count or poor sperm motility (movement).
• ICSI is often used when male sperm issues are known or suspected or after previous IVF attempts did not fertilize the egg.
• The ICSI process has significantly improved the treatment of male infertility with IVF, increasing the chances of egg fertilization compared with conventional IVF without ICSI.

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What is ICSI with IVF?

ICSI, or intracytoplasmic sperm injection, is an advanced fertility treatment technique used in conjunction with IVF. In a typical IVF cycle, our embryologist places many sperm next to an egg in a lab dish to facilitate natural sperm penetration and egg fertilization resulting in an embryo. However, before a sperm can fertilize the egg, it must first attach to and penetrate through the outer layer of the egg (the zona pellucida) to reach the inside (cytoplasm) where fertilization occurs.

Sometimes the sperm cannot penetrate this outer layer due to problems with the sperm’s health or issues of sperm delivery. Increased thickness of the egg’s zona pellucida can also hinder sperm penetration.

In such cases, ICSI offers an alternative by enhancing fertilization through the direct injection of a single sperm into the egg. For those undergoing IVF due to male infertility diagnosis, the Centers for Disease Control and Prevention (CDC) reports a marked increase in egg fertilization using ICSI compared with IVF cycles without ICSI.

This technique is particularly effective for couples experiencing male factor infertility, as it bypasses common issues related to sperm count, function or motility, which is the ability to swim properly. By placing the sperm inside the egg, intracytoplasmic sperm injection enhances chances of fertilization for sperm with difficulties in reaching or penetrating the egg on their own. A semen analysis is the primary way we evaluate aspects of sperm health.

IVF with ICSI vs. conventional IVF: Which is right for you?

Patients’ decision between traditional IVF and ICSI IVF is based on the cause of infertility. ICSI is often recommended for couples or individuals dealing with the following issues.

• Male infertility due to low sperm count, poor sperm motility or abnormal sperm morphology (shape). These can affect the ability of sperm to make it through the female reproductive tract, or the IVF medium sperm and egg are placed in during IVF; sperm morphology can affect the sperm’s ability to penetrate an egg.
• Previous IVF failure: If fertilization was unsuccessful during previous IVF cycles.
• Frozen sperm: When using thawed sperm, which may be of lower quality than fresh samples.
• Couples with unexplained infertility who wish to minimize the risk of a failed fertilization cycle using standard non-ICSI fertilization methods.
• When the egg’s zona pellucida layer is too thick for sperm to penetrate it to enter the cytoplasm for fertilization; this may commonly occur in women over 38 or those women with reduced egg reserve.
• Fertilization of limited eggs: For couples with a limited number of eggs available after retrieval, maximizing fertilization through ICSI can improve the chance of success.
• Eggs that were previously frozen and then thawed: Freezing and then thawing eggs may harden the zona pellucida and reduce the chance of normal fertilization.
• Preimplantation genetic testing (PGT) cases: When performing embryo biopsy and PGT to assess the health of the embryo, some laboratories prefer ICSI to allow for more precise results and reporting outcomes.
• Male infertility due to retrograde ejaculation in which sperm goes backward into the bladder, lack of ejaculation, and when sperm must be retrieved surgically from the testicles or epididymis, such as in cases of vasectomy or blockage.

ICSI performed in the IVF lab offers greater control over the fertilization process, making it an effective option for many types of IVF cases.

The intracytoplasmic sperm injection procedure

The ICSI procedure begins like a standard IVF cycle, where eggs are retrieved from the ovaries after ovarian stimulation. In traditional IVF, fertilization occurs by placing 50-100,000 swimming sperm next to the egg in a laboratory dish, allowing one sperm to naturally enter the egg’s cytoplasm.

Steps of the ICSI process

1. Egg retrieval: After stimulating the ovaries with medication, eggs are collected during an egg retrieval which is an outpatient procedure performed under sedation.
2. Sperm collection and preparation: A sperm sample is obtained and prepared, with healthy sperm isolated for use.
3. Intracytoplasmic injection: Using a tiny needle called a micropipette, an embryologist using high-powered microscope guidance injects one healthy sperm directly into the cytoplasm of each mature egg.
4. Fertilization monitoring: After the injection, eggs are monitored in the lab for signs of fertilization.
5. Embryo transfer: Once fertilization occurs, the fertilized egg, now called an embryo, grows in the lab for 1 to 7 days before being transferred to the uterus for potential implantation.
6. Other options include preimplantation genetic testing of the embryos using embryo freezing embryo biopsy.

IVF with ICSI success rate

The IVF with ICSI success rate is encouraging, but it’s important to understand the nuances involved. While the ICSI process significantly increases the likelihood of fertilization by bypassing many barriers to sperm-egg interaction, it doesn’t guarantee pregnancy. The overall success of ICSI depends on several key factors, such as the quality of both the eggs and sperm, as well as the reproductive health of the couple or individuals.

The American Society for Reproductive Medicine reports that ICSI successfully fertilizes between 50% and 80% of injected eggs. But this range can fluctuate based on individual circumstances like maternal age, ovarian reserve and the presence of any underlying fertility issues in either partner. For example, younger women with good ovarian function and healthy eggs tend to see higher success rates, while diminished egg quality due to age or health conditions can lower the chances of successful fertilization, even with ICSI.

Talk with your fertility specialist about the risks and considerations

While intracytoplasmic sperm injection can improve fertilization success over IVF attempts without ICSI, it cannot improve egg or embryo quality or guarantee successful birth. So even IVF with intracytoplasmic sperm injection may still be unsuccessful.

As with any fertility treatment, there are potential risks associated with the procedure. These include:

• Damage to eggs: The injection process may occasionally damage eggs, although this risk is minimal when performed by Conceive NJ’s experienced professionals.
• Embryo development issues: Not all fertilized eggs develop into viable embryos.

It’s important to discuss the risks and benefits with your fertility specialist to make an informed decision about your treatment options.

In conclusion on ICSI for our New Jersey patients

For couples facing male infertility challenges undergoing IVF, ICSI provides an effective solution, particularly when IVF alone has not succeeded. Male infertility factors related to sperm health and its delivery can make it difficult for sperm to penetrate the egg naturally. Intracytoplasmic sperm injection is also an effective approach for those experiencing unexplained infertility and for women with eggs that are difficult for sperm to penetrate.

The procedure with IVF has opened doors for many individuals and couples striving to build their families, allowing them to overcome specific barriers to conception. For patients considering IVF with ICSI, scheduling a consultation with our fertility specialist is a great first step. Dr. Isaac Glatstein can guide you through the process, review your unique circumstances and help you make an informed decision about your path to parenthood.