What is ICSI?
ICSI is intracytoplasmic sperm injection. Male infertility is mainly due to no sperms, low sperm counts, diminished motility and high percentage of abnormal sperm count. Intracytoplasmic Sperm Injection (ICSI) is the answer to tackle male infertility and failed fertilization in IVF. In ICSI, a direct injection of a single spermatozoon in a mature oocyte is carried out with help of micromanipulator under inverted microscopic guidence. Semen of male patients is washed and a single sperm, which is morphologically normal, is selected and injected in the oocyte with a very fine needle. Rests of the basic steps are similar to IVF.
Surgical retrieval of sperms for ICSI:
(In patients with azoospermia due to vassal or epididymal blocks) When semen analysis shows absent sperms but testicular biopsy shows production of sperms in testes then various surgical sperm retrieval techniques are used to retrieve the sperms from testes or the collection system. ICSI treatment is done with these surgically retrieved sperms to achieve the pregnancy. These techniques are
- Testicular sperm aspiration (TESA)
- Testicular sperm extraction (TESE)
- Percutaneous epididymal sperm aspiration (PESA)
- Microepididymal sperm aspiration (MESA)
- Vas deferens aspiration (VDA)
- Spermatocele aspiration
How much is the success rate of IVF –ICSI ?
Success rate of IVF-ICSI:
The success of conception and pregnancy depends on causes of infertility in a couple, age of female partner, number and grade of embryos transferred, experience of treating doctors, IVF lab standard and many other factors. In our center, the rate of fertilization with ART is 90 to 100% with 45 to 55% pregnancy having attained with ICSI, practically over-ridding male factor. 45 to 55% is the current rate of pregnancy in our center with IVF -ICSI procedures. This success rate is comparable with worldwide success rate of IVF-ICSI. There is of course no specific age limit for couples who may be considered for IVF-ICSI in our center, but as per ICMR guidelines pregnancy is not advocated after the age of 50 years for female partner.
What are the causes of failure of IVF-ICSI?
Following are the causes of failure of IVF-ICSI in infertile couple:
- Female Age: : female age is very important in fertility outcome. As the age of female increases, the oocyte number decreases and oocyte quality deteriorates. Some genetic changes also occur in ageing oocytes, that affect the fertilization rates.
- Poor oocyte quality:some patients have poor quality oocytes, that gives defective embryos, which does not grow after embryo transfer
- Uterine factors: Some uterine factors like congenital uterine malformations, uterine fibroids, endometrial polyps, infections can cause failure of IVF treatment.
- Poor endometrium: In some patients the endometrial lining of uterus may be thin or defective due to previous uterine infections( tuberculosis most common), surgeries, etc. This hampers implantation of embryos, even if the embryos are of best quality.
- Severe male factor infertility: Severe semen abnormalities like poor sperm motility, structurally abnormal sperm defects
- Unexplained causes: Ultimately pregnancy is a natural phenomenon. Even if all fertility factors are apparently normal, we get best quality embryos, the success rate is in the range of 45 to 55% at present, in the best IVF centers in the world, in a single treatment cycle. There might be undetected factors in the couple that cause failure of pregnancy after IVF-ICSI cycle or it could be a natural outcome.
- Emotional stress and lifestyle causes: The couple, particularly female, may be under tremendous stress during treatment of IVF. Excessive emotional stress may cause hormonal imbalance, leading to failure of pregnancy. Patient should try stress relaxation exercises like yoga, meditation, regular exercise and proper counseling before and during treatment.
- Laboratory standards: The IVF center should maintain adequate laboratory environment favorable for fertilization and culture of gametes and embryos. Also, experience of the IVF center, treating fertility specialists and biologists matters.
What are the indications for surrogate mother?
- Absent uterus
- Severe uterine defects causing pregnancy failure
- Recurrent pregnancy failures