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ICSI -Intracytoplasmic Sperm Injection
Intracytoplasmic Sperm Injection (ICSI) is a technique where a single sperm is given a helping hand to ‘enter’ the egg. This method is especially successful in overcoming male infertility problems.
The ICSI Process
Step 1: Sperm selection
It’s a real skill to spot morphologically normal ‘ideal’ sperm cells – they need to have a particular shape and size in many parts of the sperm cell. These sperm have an oval head and a long tail, which they use to help them swim. Men with infertility issues often make fewer such sperm, which is why sperm selection for ICSI is so vitally important.
The next thing to consider is sperm motility or movement. Essentially, a sperm with good motility can move itself around and penetrate an egg. This movement depends on the length and size of the sperm’s tail. Tails that are curly or doubled up can’t swim as efficiently.
To select the best sperm for ICSI, the embryologist places a small amount of washed and prepared sperm into thick, viscous media.
This slows the sperm down, making it easier to observe and identify the ideal sperm based on their shape, motility and trajectory (direction).
Once our embryologists have selected the most morphologically normal and vigorous sperm, they immobilise them by striking their tails with a glass injection needle.
They then aspirate (suck up) a single sperm into the needle tail-first, ready to be injected into the egg.
Step 2: Injecting the sperm into the egg
First, our embryologist places the egg in a customised dish under a microscope, moving it using advanced micro-manipulators. Next, they search for the ideal sperm for injection and, immobilise this sperm and position it in the injection pipette. Then, they use a holding pipette to secure the mature egg in place. Finally, a thin, sharp glass micropipette – loaded with a single sperm – pushes first through the zona pellucida (the outer egg casing) and then the oolemma (the cell membrane of the egg) to enter the egg’s centre (the cytoplasm). The embryologist deposits the sperm ever so delicately into the centre of the egg.
In other words, our scientists do all of the work for the sperm – no swimming or penetration of the egg is involved. The only thing left for the sperm to do is to fertilise the egg.
Step 3: Fertilisation
After the ICSI procedure, we place the egg into our specialised culture incubators to assess for fertilisation. ~17 hours later, the next day, looking for signs of regular fertilisation, two pronuclear bodies known as ‘pronuclei’. These pronuclei are the genetic nucleus from the egg and sperm, so we need to see only two pronuclei, one from the egg and one from the sperm. If the egg does not present with two pronuclei, then the egg has not been fertilised and will not produce an embryo.
Our embryologists will sometimes spend hours searching for the perfect sperm for ICSI, especially in patients with a low sperm count or poor motility. We stop at nothing to find the ideal, most vigorous sperm.
Why would I consider ICSI over standard IVF?
If you think ICSI might be right for you, it’s a good idea to talk through the process with your fertility specialist. They’ll tailor a treatment plan to your circumstances to give you the very best chance of success.
Read “The Vienna Consensus: Report of an Expert Meeting on the Development of Art Laboratory Performance Indicators.” Reproductive BioMedicine Online, vol. 35, no. 5, 2017, pp. 494–510, https://doi.org/10.1016/j.rbmo.2017.06.015.
Are there any risks involved with ICSI?
ICSI is more invasive and requires more handling than standard IVF insemination techniques. So, the egg may be damaged during the ICSI procedure. Current statistics indicate that damage to eggs after ICSI occurs in 5-10% of cases [1]. Unfortunately, this could result in a non-viable egg.
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