Intracytoplasmic Sperm Injection for Infertility

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Intracytoplasmic Sperm Injection for Infertility

Treatment Overview

Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat sperm-related infertility problems. ICSI is used to enhance the fertilization phase of in vitro fertilization (IVF) by injecting a single sperm into a mature egg. The fertilized egg is then placed in a woman's uterus or fallopian tube.

Sperm collection. If sperm cannot be collected by means of masturbation, they are surgically removed from a testicle through a small incision. This method of sperm retrieval is done when there is a blockage that prevents sperm from being ejaculated or when there is a problem with sperm development. To screen for possible genetic problems that could affect offspring, experts recommend that men with little or no sperm in their semen (not due to a blockage) have genetic testing before they proceed with ICSI.2

Ovulation and egg retrieval. To prepare for an assisted reproductive procedure using your own eggs, you must get daily injections and be closely monitored for 2 weeks before egg retrieval. At home, you or your partner injects you with gonadotropin or follicle-stimulating hormone (FSH) to stimulate your ovaries to produce multiple eggs (superovulation). After the first week, your doctor checks your blood estrogen levels and uses ultrasound to see whether eggs are maturing in the follicles. During the second week, your dosage may change based on test results and ultrasound. If follicles fully develop, you are given a human chorionic gonadotropin (hCG) injection to stimulate the follicles to mature. The mature eggs are collected 34 to 36 hours later using laparoscopy or needle aspiration guided by ultrasound through the abdomen to the ovaries.

Sperm injection and transfer. Under high-power magnification, a glass tool (holding pipet) is used to hold an egg in place. A microscopic glass tube containing sperm (injection pipet) is used to penetrate and deposit one sperm into the egg. After culturing in the laboratory overnight, eggs are checked for evidence of fertilization. After incubation, the eggs that have been successfully fertilized (zygotes) or have had 3 to 5 days to further develop (zygotes or blastocysts) are selected. Two to four are placed in the uterus using a thin flexible tube (catheter) that is inserted through the cervix. The remaining embryos may be frozen (cryopreserved) for future attempts.

What To Expect After Treatment

Overall, in vitro fertilization (IVF)-related injections, monitoring, and procedures are emotionally and physically demanding of the woman. Superovulation with hormones requires regular blood tests, daily injections (some are quite painful), and frequent monitoring by your doctor.

These procedures are done on an outpatient basis and require only a short recovery time. Your doctor may advise you to avoid strenuous activities for the remainder of the day.

Why It Is Done

Intracytoplasmic sperm injection (ICSI) is used to treat severe male infertility, as when little or no sperm are ejaculated in the semen. Immature sperm collected from the testicles are usually unable to move about and are more likely to fertilize an egg through ICSI.

Some couples choose to try ICSI after repeat in vitro fertilization has been unsuccessful.

ICSI is also used for couples who are planning to have genetic testing of the embryo to check for certain genetic disorders. ICSI uses only one sperm for each egg. So there is no chance the genetic test can be contaminated by other sperm.

How Well It Works

Used with in vitro fertilization and eggs of good quality, ICSI often is a successful treatment for men with impaired or no sperm in the ejaculate. ICSI (using sperm collected from the testicles) produces an estimated 25% to 30% birth rate.3

ICSI does not improve the chances of conception for men with good-quality sperm in the ejaculate.4

Risks

Risks related to ICSI are the same as for in vitro fertilization, which increases the risks of ovarian hyperstimulation syndrome and multiple pregnancy.

  • Superovulation with hormone treatment can cause severe ovarian hyperstimulation syndrome, occurring in 0.5% to 2% of all IVF treatment cycles.4 Your doctor can minimize the risk of ovarian hyperstimulation syndrome by closely monitoring your ovaries and hormone levels during treatment.
  • Approximately 30% of births in Canada that result from assisted reproductive technologies such as IVF produce pregnancies with twins or more.1 Multiple pregnancies are high-risk for both a mother and her fetuses.

There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as ICSI. Talk with your doctor about these possible risks.

Treatment success versus the risk of multiple pregnancy

In order for a woman over age 35 to maximize her chances of conceiving with her own eggs and carrying a healthy pregnancy, she must have more embryos transferred than do younger women. This practice, though, increases her risk of conceiving multiple fetuses.

Because of the risks of multiple pregnancy to the babies, experts recommend limiting the number of embryos transferred. Based on your age and your situation, your doctor will recommend a certain number of embryos to be transferred.

Women over 40 have a high rate of embryo loss when they use their own eggs. As an alternative, older women can choose to use more viable donor eggs.

What To Think About

Doctors advise men who have little or no sperm in their semen (not due to a blockage) to have genetic testing before ICSI.2 Intracytoplasmic sperm injection is an effective treatment for sperm-related infertility, but it may carry genetic risks. Couples diagnosed with a chromosomal problem can seek genetic counselling to learn their potential for having a child with birth defects.

If you and your doctor are concerned about passing on a genetic disorder to your child, talk to your doctor about pre-implantation genetic diagnosis. Some genetic disorders can be identified with specialized testing before an embryo is transferred.

Frozen embryos are often less expensive and less invasive for a woman, because superovulation and egg retrieval aren't needed.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

Citations

  1. Canadian Fertility and Andrology Society (2009). Human assisted reproduction 2009 live birth rates for Canada. Available online: http://www.cfas.ca/index.php?option=com_content&view=article&id=924%3Ahuman-assisted-reproduction-2009-live-birth-rates-for-canada&catid=929%3Apress-releases&Itemid=460.
  2. American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). Evaluation of the azoospermic male. Fertility and Sterility, 90(Suppl 3): S74–S77.
  3. American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). The management of infertility due to obstructive azoospermia. Fertility and Sterility, 90(Suppl 3): S121–S124.
  4. Al-Inany H (2005). Female infertility, search date April 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Last Revised April 27, 2010

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