Last week we discussed artificial insemination. This week we will discuss intracytoplasmic sperm injection (ICSI) for the treatment of severe male factor infertility. ICSI has been a tremendous benefit to assisted reproductive technologies for over a decade and has revolutionized the treatment for couples who have severe male infertility.
One severe male factor that requires the use of ICSI is severe oligospermia (total sperm count < 5 million). When there is a severely low amount of sperm available, the chance of fertilization of the egg becomes extremely low. As a result, an assisted fertilization technique called intracytoplasmic sperm injection (ICSI) must be employed.
With ˜conventional’ IVF, processed sperm is combined with the eggs, and the sperm naturally swim up to and penetrate the egg. In the ICSI procedure, the embryologist sifts through the sperm specimen to identify a single healthy appearing sperm. This single healthy sperm is gently drawn into a pipette. The egg is stabilized. The embryologist then skillfully pierces the shell of the egg with the pipette and the sperm is injected directly into the interior of the egg. This effectively leads to fertilization of the egg.
Here are some photos of Intracytoplasmic Sperm Injection (ICSI):
Prior to the development and advancement of ICSI, it would not be unusual for a couple with severe male factor to have very poor or absent fertilization with conventional IVF. Now couples with severe male factor often have equivalent pregnancy rates to couples without a male factor.
Some other severe male factor conditions requiring ICSI include:
1. Men with a very poor semen analysis, which may include a low concentration, poor motility, or poor morphology (shapes of the sperm).
2. Men who produce sperm in low quantity and have absence of sperm in the ejaculate. They require a testicular biopsy to obtain sperm that can be used for the IVF/ICSI cycle. Some men who have had certain types of chemotherapy may have compromised sperm production and are in this category.
3. Men who have had vasectomies. If a man has had a vasectomy and does not wish to have a reversal, a testicular or epididymal biopsy can be done to obtain sperm that can then be used for IVF/ICSI.
4. Couples who have had poor fertilization with ˜conventional’ IVF on a previous cycle.
5. Men who produce sperm, but are born without a vas deferens (part of the outflow tract). These men will require either a testicular or epididymal biopsy to retrieve their sperm and then use ICSI to ensure fertilization.
For more information about ICSI, is available on our Dallas IVF website.
Next week we will discuss the IVF process.
Lowell T. Ku, M.D. is a Reproductive Endocrinology and Infertility specialist at Dallas IVF and clarifies the many confusing terms used in the world of Infertility therapy using straightforward explanations.
Source: Speroff L, Fritz MA, Clinical Gynecologic Endocrinology and Infertility , 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2005: 1236-37.