Let’s Talk About ICSI (Intracytoplasmic Sperm Injection)

While many people think of infertility as a woman’s issue, the truth is nearly 50% of all infertility cases have to do with men. For many years severe male factor infertility was considered to be almost untreatable. Then, in the mid-1990s a new procedure, called intracytoplasmic sperm injection (ICSI) was discovered, almost by accident. This procedure now allows couples, who thought pregnancy was impossible because of a male’s lack of sperm, to conceive and bear healthy children.

The Discovery

Two young assistants in a fertility lab in Brussels, Belgium, were working with a patient’s eggs. Their job was to use a needle to insert sperm just under the outer coating of the egg, and then leave it to the sperm to work its way inside. Sperm had never been injected the entire way inside an egg, because it was believed the injection would cause too much damage and make it impossible for the embryo to develop. The lab assistants accidentally punctured the membrane of an egg, inserting a single sperm directly inside. They were certain the egg would be destroyed, but instead what they found was after a day, they had produced a healthily dividing embryo. Instead of losing their jobs, they had accidentally discovered a procedure that would allow any man, with even just a few sperm, to genetically father a child.

Who it can help

ICSI is nearly identical to in vitro fertilization (IVF). First ovulation is stimulated, and then the eggs are retrieved. The sperm is then collected, fertilization is completed in the lab and the embryo is transferred back into the uterus. The difference is the number of sperm needed for fertilization and how fertilization occurs. In IVF a concentrated solution with a large number of sperm is placed in a dish, with several eggs. The sperm are allowed to fertilize the eggs, just as they would if the process was occurring inside the women’s body. Once the embryos begin developing, they are transferred into the woman’s uterus. With ICSI, only a single sperm is needed to fertilize an egg. Finally, men who previously couldn’t produce enough quality sperm for IVF and who were considered functionally sterile, were now given the chance at fatherhood. ICSI allows fertilization using sperm, from men with extremely low production, deprived sperm quality and poor motility.

Because only a small number of sperm are needed (approximately 10 instead of 10 million), ICSI makes fertilization possible for men who have had cancer treatments, patients who had mumps, men with undescended testicles and men who simply were not able to produce many sperm. Minor surgery is performed in the man, to find sperm in the coils of his testicles; those few sperm can be used to produce healthy children. No matter what causes male infertility, ICSI works around the problem; giving better results for a healthy pregnancy.

Sperm Aspiration and Fertilization

Normally sperm are collected either through masturbation, or with a collection condom that is used during intercourse. If there are no sperm in the ejaculate, the sperm can be obtained directly from the testicles. One method is called Testicular Sperm Extraction, or TESE. In this procedure, a special biopsy technique is used to remove a small portion of testicular tissue. In a laboratory, sperm are extracted from the tissue and evaluated for use. The other procedure is called Microsurgical Epididymal Sperm Asipiration (MESA). The epididymis is a thin coiled tube, which collects maturing sperm from the testicles. A needle is used to extract fluid from the epididymis, and sperm are extracted from the fluid in the laboratory.

Once the sperm have been extracted, the eggs harvested from the female are treated to remove the surrounding membrane. Each egg is held carefully, and then a single sperm is injected into each egg. The fertilized eggs are put into an incubator and monitored for several days, after which they are implanted into the woman’s uterus, just like they would during IVF.

Risks and Successes

Generally there is little discomfort for the male during sperm collection, and risks with ICSI are infrequent. They may include infection, bleeding, multiple pregnancy and ovarian hyperstimulation syndrome. Some of these are risks also associated with IVF. There is concern that there is a link between ICSI and an increased incidence of birth defects; however extensive research has shown that no higher incidences of birth defects occur in babies produced from ICSI than those in the general population.

Success rates for ICSI are approximately 30%, which is roughly the same as with IVF. The significance of ICSI, however, lies in the number of couples who were previously unable to try IVF without the aid of a sperm donor.

While ICSI does not eliminate the stress and commitment of infertility procedures, it does however, open the door to the possibility of conception, for thousands of couples that were previously considered sterile, due to male factor infertility.