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Intracytoplasmic Sperm Injection (ICSI) is a specialised form of invitro fertilization that is used primarily for the treatment in cases with male factor infertility, after repeated fertilization failures with conventional IVF, or after egg freezing (oocyte preservation).
INDICATIONS FOR ICSI
Male factors (oligozoospermia, severe asthenozoospermia, teratozoospermia)
Surgically retrieved spermatozoa
High titers of antisperm antibodies
Zona hardening in the eggs
Frozen thawed oocytes
Fertilization failures in previous cycles
Frozen thawed sample with compromised motility
The ovaries are stimulated with medication to promote the growth of the follicles containing eggs.
With ultrasounds and blood tests the response of the ovaries are monitored, to control the size and quantity of follicles
HCG TRIGGER is administered for the final maturation of the egg and retrieval is done within 36-38 hours of the trigger.
After retrieval of eggs, the oocytes are surrounded with cumulus cells which are gently removed using gentle enzyme to observe the maturity of the oocytes.
The semen sample is processed in order to select good quality sperm.
The genetically matured oocytes are individually injected with sperm with the delicate maneuvering of micromanipulators.
The injection is done with the precise microtools and post insemination the oocytes are cultured in the ambient culture conditions in the incubators which mimics the uterine environment.
After 16-18 hours post ICSI fertilization is observed.
Embryos are cultured for 2-5 days in the laboratory and everyday the growth status is monitored.
The embryo chosen for the transfer is loaded into the catheter which is passed through the cervix into the uterus under the guidance of ultrasound and gently released.
The good quality embryos are frozen and stored. These frozen embryos can be used in the subsequent cycles if the first cycle is not successful or for the second pregnancy.
A sophisticated advancement to ICSI is IMSI- Intracytoplasmic morphologically selected sperm injection. Prior to the sperm injection/ insemination into the ovum, the morphology of the sperm cell is evaluated with high magnification microscopy.
With MSOME - motile sperm organelle morphology examination, the fine nuclear morphology of motile spermatozoa is examined to asses over six sperm organelles.
This technique is advocated only in highly DNA fragmented sperms or with very poor morphology of the sperms (teratozoozpermia).
PICSI - physiological intracytoplasmic sperm injection is a technique used in order to select best possible sperm for better fertilization in intracytoplasmic sperm injection (ICSI).
Sperms are placed in the PICSI dish which contains spots or droplets of the hyaluronan hydrogel– which is a naturally occurring biopolymer found in all human cells, which is present in the outer sheath of the ovum as well.
Sperm bound to this hyaluronan are mature, biochemically competent and exhibit lower percentage of chromosomal aneuploidies and DNA damage and show better chromatin condensation with enhanced genetic and developmental integrity to ensure better fertilization and embryo growth.
The sperms selected by this method found normal as per MSOME criteria which is used in IMSI. The selected sperm is essentially the same as the one which would be successful in the natural reproductive process.
PICSI is highly recommended in these particular cases:
Previous failure or low fertilization even after ICSI
Low embryo quality or their failure to develop