Intracytoplasmic Sperm Injection: ICSI

ICSI has revolutionized the treatment of male infertility. Many couples do not realize that male factor is such a large contributor to the disease of infertility. Studies have found that there is a contributing male infertility problem in approximately 49% of cases. Many characteristics of sperm contribute to its ability to fertilize eggs.

Given the prevalence and importance of male infertility, a laboratory experienced in reproductive medicine must perform a thorough semen analysis. Commercial laboratories that may be promoted by managed care plans may not have extensive experience evaluating sperm.

In vitro fertilization (IVF) offers hope to couples who cannot become pregnant using methods such as timed intercourse, IUI, fertility drugs, etc. In particular, women with blocked, diseased, or absent Fallopian tubes can now become pregnant using IVF. Another advantage of IVF is that it allows direct visualization of the fertilization process. The embryologist can determine if the eggs are being fertilized. In IVF, the sperm is concentrated around the egg which increases the probably of fertilization.

However, the male still has to produce sufficient quality and quantity of sperm to penetrate an egg and cause fertilization. Intracytoplasmic sperm injection allows men with very low sperm counts to father children. It is also possible for a male with no sperm in his ejaculate (if sperm can be extracted from the testes) to produce a genetically related child. Through ICSI men with severe spinal cord injury can father children and it is also used in cases of unknown infertility, advanced female age, severe endometriosis, and other conditions.

In the ICSI procedure, a small hole is created in the egg membrane, chemically, mechanically, or using a laser and the sperm is inserted directly into the egg using a very fine microscopic needle and delicate micromanipulation tools. Sperm can be obtained directly from the testes in testicular epididymal sperm aspiration. It can also be obtained from the mesothelial lining of the epididymis (tube that transports the sperm). This means that an ejaculate is not always necessary to isolate sperm for use in ICSI.

Intracytoplasmic sperm injection / ICSI is a very safe procedure and studies demonstrate no significant increase in birth defects or other disorders after ICSI. We offer ICSI to our patients as indicated by their clinical diagnosis.