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Thanks to the introduction of assisted reproductive technologies, many couples diagnosed with infertility have been able to become parents. FROM gynecologist Lyudmila Shurshina Let’s talk more about the ICSI method.
Who needs IVF ICSI?
The IVF method ICSI is recommended for couples who have had unsuccessful IVF attempts or did not fertilize the egg during the procedure.
The main indications for IVF ICSI are:
- pathological changes in the seminal fluid (insufficient number of spermatozoa, i.e. oligozoospermia, poor sperm motility, a large number of pathologically altered spermatozoa, i.e. teratospermia, absence of spermatozoa, i.e. azoospermia, etc.);
- obstruction or absence of the vas deferens (congenital absence or condition after vasectomy);
- impotence;
- the content of antisperm antibodies in semen;
- lack of fertilization or low percentage of fertilization in the previous IVF program;
- a small number of eggs received (less than 4);
- low quality of “thawed” spermatozoa;
- infertility of unknown origin.
When using the IVF ICSI method, the sperm will enter the egg and fertilization will occur regardless of the quality of the sperm (1).
How is IVF ICSI carried out?
As with standard IVF, after the preparatory period (passing tests and passing examinations) in the IVF ICSI method, everything starts with stimulation of superovulation. A woman is prescribed hormonal preparations for the maturation of eggs. But there are options when the IVF ICSI procedure is carried out in a natural cycle, without ovarian stimulation. After maturation of the follicles, chorionic gonadotropin (hCG) or a gonadotropic releasing hormone (GnRH) agonist is injected. After 36 hours, a transvaginal follicle puncture.
The procedure takes place under general anesthesia. A special hollow needle is inserted through the vagina under the control of an ultrasonic sensor and mature eggs are removed from the follicles.
They are sent to the laboratory, where they are examined and evaluated by an embryologist (2). Oocytes are located in special nutrient media. For the ICSI procedure, only mature eggs are used. If they are not ready, they are laid in an incubator until full maturity.
Spermatozoa can be collected by testicular biopsy (for very poor sperm quality, azoospermia). The embryologist selects the highest quality and viable sperm.
The main selection criteria:
- mobility. The sperm must move in a straight line at a speed of 25 microns/sec or more;
- morphology. The sperm must have a correct and proportional structure: an elliptical head, neck and tail; also, the head of the sperm should not be disproportionately large.
Next stage – fertilization of the egg.
On a glass slide under a microscope, the doctor places the selected sperm and a mature egg, which he fixes with a microscopic suction cup. Cuts off the tail of the spermatozoon so that it does not have the opportunity for arbitrary movement. And the head, which carries genetic information, is placed in a microneedle. Then, with this needle, the oocyte membrane is punctured and the spermatozoon is introduced into its cavity.
After the process starts embryo culture on a nutrient medium. Within 5-6 days, the specialist monitors the development of the embryos and evaluates their viability. On the 5th (rarely 3rd) day of development, the highest quality embryo is transferred into the uterine cavity. A woman is prescribed hormonal drugs and after 12-14 days with the help of a test, ultrasound and a blood test for hCG, you can find out whether pregnancy has occurred or not.
Reviews of specialists about ICSI
The ICSI method is performed according to indications and is a possible component of the IVF protocol. When using intracytoplasmic sperm injection, IVF becomes more costly. Reviews of ICSI show: when there are problems with the quality of sperm in a partner, with repeated unsuccessful IVF attempts, when diagnosing immune infertility, this procedure is very effective and egg fertilization is guaranteed. The ICSI method has an advantage: it becomes possible to become pregnant even if the reproductive function of a man is impaired (3).
Popular questions and answers
Couples who want to conceive a child with ICSI are interested in the intricacies of the process. With gynecologist Lyudmila Shurshina, we answer the most popular questions about the procedure.
How much does the program cost?
What are the chances of success the first time?
What is the difference between conventional IVF and ICSI?
1. Method of fertilization. In classical IVF, the egg and sperm obtained by puncture are placed in a nutrient medium, where, according to natural selection, the most active and high-quality sperm enters the oocyte on its own. With the ICSI method, the embryologist uses a microscope and a very thin glass needle to inject the selected spermatozoon into the cytoplasm of the egg.
2. The main indications for the IVF procedure are: endometriosis, lack of ovulation, tubal factor, etc. The use of the ICSI method is addressed in case of male factor infertility (azoospermia, teratospermia, oligozoospermia, etc.).
Is it possible to pass the OMS program?
Sources of
- Clinical significance of spermatozoa morphology in the choice of treatment for male infertility / Olefir Yu.V., Monakov D.M. // 2021
- Endometrial factor of infertility in patients of late reproductive age (review) / Uryupina K.V., Kutsenko I.I., Kravtsova E.I., Kudlay Yu.V., Kravtsov I.I. // 2020
- Influence of the male factor of infertility on the effectiveness of the use of assisted reproductive technologies / A.V. Markin, E.V. Vartanyan, K.A. Tsaturova, N.V. Kibardina, T.A. Anikina // 2009