In normal conception, a single ejaculation of semen might contain more than 200 million viable sperm but from this vast number only a few hundred will actually reach the released egg in the fallopian tube and just one will fertilize it. Men with total sperm counts below 20 million or so (or 5 million per millimeter) were always thought impossible to treat, but now ICSI can achieve fertilization with just one sperm cell injected in to an egg.
ICSI is the latest and most successful procedure for treating male infertility. A single sperm is injected into an egg by using the high-tech gamete micromanipulation system. The treatment is available only in a few centres in India. It requires only one viable spermatozoon to achieve pregnancy whereas, a few million sperm cells are required in IVF.
Steps in ICSI:
- Drug treatment to stimulate several eggs to mature.
- GnRH agonists to suppress all other hormone activity (Injection for usually) two weeks before Gondadotropin and then a further 10 – 14 days depending on response, a new type of injection drug known as a GnRH antagonist will reduce this treatment phase by more than a week.
- Monitoring of treatment to measures the growth of Follicles, individualize drug doses and prevent serious side effects.
- By transvaginal ultrasound scanning (two or three times during a treatment cycle). Sometimes by measuring hormones in a blood sample.
- Egg collection, usually under local anesthetic lasts between 10 and 20 minutes. Guided by transvaginal ultrasound collected through the vagina (32 – 36 hours after final hormone injection).
- Sperm sample, provided on the same day as egg collection. The sample can be obtained in a natural way or following aspiration from the epididymis (PESA /TESA) or extraction from the testis (TESA).
- Fertilization: One sperm cell is injected into a single egg.
- Eggs are examined the next day under the microscope to see whether fertilization has occurred.
- Embryo Transfer (usually two or three days after fertilize transvaginal transfer of no more than three embryos.
- Embryos placed in the womb.
- Good quality spare embryos usually frozen.
- Pregnancy testing / monitoring