Fertility Treatment Options : ICSI and IVF for Male Infertility, Sperm Injection Into Eggs

Intracytoplasmic sperm injection (ICSI) can be used as part of an in vitro fertilisation (IVF) treatment to help you and your spouse to conceive a child. 

ICSI is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments. 
ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb).

Common reasons used for performing ICSI

1.     Severe male factor infertility that do not want donor sperm insemination.

2.     Couples with infertility with:

o    Sperm concentrations of less than 15-20 million per milliliter

o    Low sperm motility - less than 35%

o    Very poor sperm morphology (subjective - specific cutoff value is debatable)

3.     Having previous IVF with no fertilization - or a low rate of fertilization (low percentage of mature eggs that were normally fertilized).

4.     Sometimes it is used for couples that have a low yield of eggs at egg retrieval. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (mixing eggs and sperm together).

How is ICSI performed?

1.     The mature egg is held with a specialized holding pipette.

2.     A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.

3.     This needle is then carefully inserted through the zona (shell of the egg) and in to the center (cytoplasm) of the egg.

4.     The sperm is injected in the cytoplasm and the needle is removed.

5.     The eggs are checked the next morning for evidence of normal fertilization.

How long does ICSI treatment last?

One cycle of ICSI takes between four weeks and six weeks to complete. You and your spouse can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You'll go back anywhere between two days and six days later for the embryo transfer procedure.

What are the success rates of ICSI?

The success rates for ICSI are higher than if you use conventional IVF methods. A lot depends on your particular fertility problem and your age. The younger you are, the healthier your eggs usually are, and the higher your chances of success. 
The percentage of cycles using ICSI which result in a live birth are:

• 35 per cent if you are under 35
• 29 per cent if you are between 35 and 37
• 21 per cent if you are between 38 and 39
• 14 per cent if you are aged between 40 and 42
• six per cent if you are between 43 and 44
• five per cent if you are over 44

What are the advantages of ICSI?

• ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you.
• If your spouse is too anxious to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI.
• ICSI can also be used to help couples with unexplained infertility, though experts haven't found that ICSI makes pregnancy any more likely than standard IVF.
• ICSI doesn't appear to affect how children conceived via the procedure develop mentally or physically
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IVF - Frequently Asked Questions - Male & Female Fertility Treatment in India

1. Are there any restrictions on physical or personal activities during an IVF cycle?

• Smoking: Stop smoking before ovulation induction begins. It is best to discontinue tobacco at least 3 months prior to an IVF cycle. If you cannot stop “cold turkey”, seek the care of your primary care physician. By products of tobacco have been demonstrated to be toxic to the oocyte (egg). We strongly recommend that all women, especially those undergoing fertility treatment, cease smoking.
• Drinking: Alcohol is a drug, and should be avoided during infertility treatment and pregnancy. Please do not drink alcohol from the time fertility medications are initiated until the pregnancy test.
• Medications: If you are taking any medication, prescription or over-the-counter, please inform your physician. Some medications may interfere with the fertility medications prescribed, some are not safe to use before an operation or medical procedure, and others might interfere with ovulation or pregnancy implantation.
• An IVF cycle can be an emotional and stressful time for you and your partner. It may be helpful to have supportive personnel to speak to, such as friends and family, a clergy member, or a psychologist/therapist.
• Heavy exercise such as aerobics, jogging, weight lifting etc. are prohibited during ovarian stimulation and until the pregnancy test results are known.
• Acupuncture is permitted prior, during and after your IVF cycle but herbal supplements are absolutely prohibited.

2. Is the egg retrieval painful?

We do our egg retrievals under anesthesia you will be asleep for the procedure. Our anesthesia specialists use medications which heavily sedate you. You will be "asleep" however; you will not require a breathing tube. The beauty of this approach is that you will feel absolutely nothing, remember absolutely nothing, and will have few of or none of the typical side effects of anesthesia such as nausea and vomiting.

3. Will the egg retrieval damage my ovaries?

The data we have available tells us that it does not. There have been many women who have undergone multiple egg retrievals. The fact that they have responded to stimulation on subsequent occasions and gotten eggs and pregnancies on these occasions implies that the ovaries are OK after egg retrieval. There have been some limited studies looking at the appearance of the ovaries in women who have had egg retrievals and subsequent laparoscopic surgery. In those patients, the findings were normal.

4. Howlong does it take to get started with IVF?

From the point of your initial consultation , you may potentially start an IVF cycle within weeks. Your physician will determine the appropriate time frame for your fertility treatment.

IVF treatment into phases:

Phase One involves your initial consult and diagnostic evaluation. This can take days, but usually takes weeks or even a couple of months (depending on your menstrual cycle, logistical and financial details such as your travel schedule, availability, insurance requirements, etc.)

Phase Two is your cycle planning stage, which is heavy on logistical details such as obtaining IVF medications and learning how to mix and administer them. There is also blood work to be done, consent forms to be signed, payment to be made as well as other details to attend to during this phase.

Phase Two can last days, weeks or months, depending on your schedule, insurance, and availability.

Phase Three is the start of the cycle and usually lasts about two weeks. During this time you will be taking injectable medications and return  every couple of days for monitoring.

Phase Four is egg retrieval and embryo transfer. There are three to five days between the time when eggs are retrieved and embryos are put back into the uterus.

Phase Five is a pregnancy test and beyond.

5. If I am not pregnant, when can we try again?

Usually we ask that patients wait one or two complete menstrual cycles before beginning another ART cycle. Sometimes tests are required that may delay subsequent cycles.

6. Are there limitations onthe number of IVF tries per couple?

We find that most couples will get pregnant within 2 tries. Occasionally, there may be a reason to do a third attempt but that is not common. More than this would really require extenuating circumstances such as a miscarriage due to a non-recurring reason, for example.

7. Is there a higher miscarriage rate for ART patients?

The miscarriage rate is about the same for ART as the general population. Many times older females undergo ART and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.

8. What are my choices if my tubes have been tied?
Basically there are two choices, surgery to try and repair the tubes or IVF. There are pros and cons to each choice and often the best choice depends on your unique situation. Surgery offers the option of attempting pregnancy naturally indefinitely without repeated treatments, but carries the rare risks of surgery and in some cases is not successful depending on the type of tubal ligation or tubal damage done initially. IVF offers the chance for pregnancy without having to undergo an operation and maintaining contraception or birth control against future pregnancies after completion of your family.

9. How do we decide how many embryos to transfer?

Your physician will discuss this with you at the time of consent signing, but we usually follow the recommendations of The American Society for Reproductive Medicine guidelines:

• Under 34 years old = 1-2 embryos
• 35-37 years of age = 2-3 embryos
• 38-40 years of age = 3 embryos

These numbers may vary depending on individual diagnosis and clinical circumstance.

10.How much does IVF cost?
The cost of IVF depends on the treatment and options selected. For IVF pricing information, click here.