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ICSI: Indications and Outcomes

ICSI is a form of IVF that involves directly injecting a single sperm into a human egg to facilitate fertilization. It is commonly used to treat male factor infertility issues like oligozoospermia, azoospermia, or sperm motility problems. ICSI can also be used when standard IVF has failed repeatedly or is the preferred method at some fertility clinics. Genetic testing of both partners is important for cases of severe male factor infertility due to risks of passing on genetic infertility. ICSI has comparable success rates to standard IVF and has largely replaced other microinjection techniques. Multiple pregnancies are a risk if more than one embryo is transferred.

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169 views7 pages

ICSI: Indications and Outcomes

ICSI is a form of IVF that involves directly injecting a single sperm into a human egg to facilitate fertilization. It is commonly used to treat male factor infertility issues like oligozoospermia, azoospermia, or sperm motility problems. ICSI can also be used when standard IVF has failed repeatedly or is the preferred method at some fertility clinics. Genetic testing of both partners is important for cases of severe male factor infertility due to risks of passing on genetic infertility. ICSI has comparable success rates to standard IVF and has largely replaced other microinjection techniques. Multiple pregnancies are a risk if more than one embryo is transferred.

Uploaded by

le sage
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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ICSI

Indications and results


Intracytoplasmic Sperm Injection

 Is a form of IVF (‘IVF with ICSI’)


 Male factor infertility
• Oligozoospermia
• Azoospermia
• Sperm motility problems
– Epididymal and testicular sperm (non-mature and
non-motile) PESA, MESA, MESE
– Cogenital BAVD (ciliary defect)
 Repeated failed standard IVF
 Changing indications : some labs now only offer ICSI. Most still
offer IVF or IVF with ICSI
Genetics
 Karyotype analysis is essential in
– severe oligozoospermia (6-7%)
– azoospermia (15%)
• mutations in the long arm of the y chromosome
Yq in the AZFc (DAZ gene). Offspring if male
will also be infertile.
– CBAVD : check for cystic fibrosis gene in patient
plus partner
ICSI
 Oocyte collection. Stimulate superovulation with human
menopausal gonadotrophin (hMG) or pure recombinant FSH,
then hCG

 Ovaries enlarge to tennis ball size. Oocytes removed by needle


aspiration through posterior fornix with TVUSS guidance

 Remove cumulus cells. Inject a paralysed sperm into the


cytoplasm.

 Fertilization rate is 60-70% with < 10 % ova damaged during


ICSI
IVF / ICSI
ICSI
Partial
Zona
Diossection
PZD

Standard IVF

Subzonal
Injection
SUZI
Results
 Sperm can be retrieved in 100% of men with obstructive
azoospermia and 50% of men with non obstructive azoospermia.
Even in sertoli-cell only etc : pockets with PESA/MESA and MESE

 In year 2000 in the UK


– 12051 cycles of IVF : 2861 live births = 23.7 % THBR
– 9322 cycles of ICSI : 2246 live births = 24.1% THBR
– < 10% oocytes were damaged during ICSI

 30-40% multiple pregnancy rate (2-3 zygotes used <35 yrs female)

 In 1998 in the UK
– 7937 babies born with IVF / ICSI : congenital abnormality rate almost
identical to general population 1.1 % / 1.6%
ICSI MCQ
 Has a significant risk of multiple pregnancy because more than
one sperm can be accidentally injected
 Has superceded partial zona dissection (PZD) and subzonal
injection (SUZI)
 Is regulated by the Human Fertilization and Embryology
Authority (HFEA) after passing of the Human Fertilization and
Embryology Act in 1990
 Is indicated only in male factor infertility
 Has had a negative impact on the thorough treatment of
obstructive azoospermia by Urologists

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