Intra cytoplasmic sperm injection (ICSI)
When Simon Fishel and his team pioneered ICSI in 1990 it revolutionized IVF treatment for couples who have male factor infertility.
IVF vs ICSI
ICSI Treatment is typically part of your IVF cycle – the difference is how fertilization is achieved. Instead of adding the sperm to the egg, a skilled embryologist uses very fine micro-manipulation equipment to inject a single sperm into each egg. Used together, IVF and ICSI are among the most common assisted reproductive techniques used around the world, and This can significantly improve the chance of fertilization if there is a low quality sperm issue. This advanced procedure has helped many thousands of couples achieve their dream of having a baby.
IMSI (Intracytoplasmic Morphologically-selected Sperm Injection)
For men with severely reduced levels of sperm morphology (size and shape) or with mid-or-high range DNA damaged sperm, there is an increased risk of miscarriage and reduced clinical pregnancy rates – even with ICSI treatment. Other treatment options for these men, such as the surgical extraction of sperm (TESE), carry surgical risk and are relatively expensive. For these patients, Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) treatment. This technique allows the laboratory to enlarge the images of sperm to over 1200 times its actual magnification. By comparison standard ICSI treatment only offers 200-400 times the magnification of sperm. The scientist then uses pre-defined sperm sizes and shape to select the most appropriate sperm to be injected into the egg. This technique offers our patients a significant increase in fertilization and pregnancy rates, and a reduction in miscarriage rates.
CANDIDATES FOR ICSI / IMSI
ICSI can help to overcome certain male infertility problems including:
- When sperm are unable to penetrate or fertilize an egg
- Low sperm count or poor sperm quality
- A blockage or anatomical abnormality in the male’s reproductive tract that prevents him from producing or ejaculating sperm
- Men who require a testicular or epididymal biopsy in order to conceive (such as after a vasectomy)
We might recommend ICSI instead of conventional IVF if:
- The quantity or quality of your sperm is unsuitable for conventional IVF treatment
- Your sperm has been collected surgically
- You’ve had low fertilization with IVF treatment previously, or haven’t been able to fertilize at all
- The egg you’re using was previously frozen.
Even if there are no issues your sperm, your consultant may still recommend ICSI with IVF. ICSI has been proven to help improve success rates for couples that have not been successful with IVF in previous cycles.
What does the ICSI procedure involve?
During the ICSI procedure we inject a single sperm directly into the centre of an egg. After a few days of development and observation in the lab, we then place the embryo in the womb in exactly the same way as with IVF treatment.
Fertilization rates are slightly higher with ICSI compared to IVF because it virtually guarantees that the sperm penetrates the egg. On average, around 75% of eggs fertilise with ICSI. Whilst there is no significant difference in pregnancy rates between ICSI and IVF, where there is a sperm issue we would usually recommend using ICSI.
Laser Assisted Hatching
Laser-assisted hatching can turn around a history of failure for embryos to implant themselves in the uterine wall. Assisted hatching is used to help the embryo hatch from its protective outer shell, the zona pellucida, and promote implantation in the uterine wall after embryo transfer.
The advent of the laser has allowed the development of precision techniques to manipulate embryos for enhanced fertility. Laser-assisted hatching can turn around a history of failure for embryos to implant themselves in the uterine wall.
Assisted hatching is used to help the embryo hatch from its protective outer shell, the zona pellucida, and promote implantation in the uterine wall after embryo transfer. Laser-assisted hatching (LAH) uses a highly focused infrared laser beam to remove the zona pellucida in very precise increments. Prior to the clinical availability of the lasers, only mechanical or chemical methods could be used for assisted hatching of human embryos in clinical settings. Laser-assisted hatching requires less handling of the embryo than these other assisted hatching methods. Also, laser-assisted hatching is faster than the other methods and, therefore, the embryo spends less time outside the incubator.
Indications for LAH
- Age :Women over 37 years old
- Hormonal Status :Women with an elevated baseline level of FSH (follicular stimulating hormone)
- Embryo Quality : Women with poor prognosis embryos, including conditions such as a thick zona pellucida, slow cell division rate, or high cell fragmentation
- IVF Attempts : Women who have failed 1 or more IVF cycles
- Frozen Embryos : Women using frozen/thawed embryos, which may have hardened zona pellucida
Does assisted hatching improve implantation rates?
Assisted hatching can improve the chances of implantation during IVF and is considered an option for patients who are able to achieve good fertilization and embryo cell development, but the zona pellucida is excessively thick and they do not conceive.
How long does it take a blastocyst to hatch?
Human blastocysts should hatch from the shell and begin to implant 1-2 days after day 5 IVF blastocyst transfer. In a natural situation (not IVF), the blastocyst should hatch and implant at the same time – about 6 to 10 days after ovulation