What is ICSI and the Implications

Note: Not taken from my clinic website



ICSI, short for intracytoplasmic sperm injection, is the direct microinjection of a single sperm into a single egg in order to achieve fertilization. It was originally developed in 1992 to assist fertilization in couples with severe male factor infertility.

Who Should Consider ICSI?

• Previous poor fertilization with IVF
• Decreased number of eggs for fertilization
• Variable sperm count
• Unexplained infertility
• Many patients choose to undergo the ICSI procedure in order to maximize their success even when the procedure may not be necessary.

What are the risks associated with ICSI?
There are several risks. First, during the ICSI procedure, a small number of eggs -- usually less than 5 percent -- can be damaged as a result of the needle insertion. Second, the overall risk of having a baby with a chromosomal abnormality in the X or Y chromosomes is 0.8 percent, or eight per 1000, which is four times the average seen with spontaneous conception. At present, we do not know the reason for this increased risk. It is important to understand that the following problems can be associated with sex chromosome abnormalities:

• Increased risk of miscarriage
• Heart problems for affected infants that may require surgery
• Increased risk of behavior or learning disabilities
• Increased risk of infertility in your children during their adulthood
• The risk of having a chromosomal abnormality like Down's syndrome is not increased with ICSI but increases with maternal age.
• Several studies that have addressed the issue of developmental delays in children born of ICSI. However, there is no conclusive evidence that this is the case.

Will all of our eggs be injected?
If you decide to proceed with ICSI, we will make every effort to inject as many eggs as possible. It is important for you to understand that only eggs that are mature can be injected with sperm. IVF laboratories can easily tell if an egg is mature or immature. Although the immature eggs are incubated with sperm, the likelihood of fertilization is very low. On average, we are able to inject 75 percent to 80 percent of the eggs that are recovered.

Are there differences in embryo quality or pregnancy rates between ICSI and non-ICSI embryos?
There appears to be no difference in the overall embryo quality achieved with ICSI embryos when compared to non-ICSI embryos. Similarly, no difference in pregnancy rates has been shown between ICSI embryos and non-ICSI embryos. Although unproven, there is a belief among many infertility specialists that ICSI may increase embryo yield from a given number of eggs recovered, which has contributed to the increase in ICSI procedures.