Intra cytoplasmic sperm injection – ICSI Treatment Cost in Chennai
What is ICSI?
ICSI stands for Intra Cytoplasmic Sperm Injection technique. It is considered as an advanced and superior form of IVF and is very relevant for severe male infertility issues. In ICSI, one sperm is injected into each egg through microinjection in lab condition to fertilise.
Since the first recorded use of frozen sperm for insemination in 1953, the breakthroughs in fertility had been mostly confined to treatments for female infertility. However, in the last decade, ICSI has transformed treatment for male infertility so much so that there are almost no men who are completely unable to father children.
The first use of ICSI in humans was announced in 1992 – since then, ICSI has completely revolutionized male infertility treatment
How different is it from Conventional IVF?
In-vitro fertilization, which translates to “in-glass” fertilization, occurs in much the same way natural conception does. Eggs are mixed with millions of sperm in a carefully controlled vessel, and the sperm flood around the egg until one of them penetrates its protective barrier, locking all the other sperm out. Just as in natural conception, this requires a very high sperm-to-egg ratio, and therefore this option will not help males with moderate to severe infertility to conceive.
Efforts to reduce the sperm-to-egg ratio needed for IVF led to the development of ICSI – in contrast to conventional IVF, ICSI only needs a sperm-to-egg ratio of 1-to-1. The process begins in the same way as conventional IVF; eggs are collected from the woman by hyper-stimulating her ovaries, and a sperm sample is collected through ejaculate or testicular sperm extraction (TESE – a method of sperm extraction directly from the testicles) for more severe cases. However, once these samples have been collected, instead of mixing them together, a single sperm is selected for implantation into the egg. This sperm is drawn up into an extremely thin pipette which is then pushed through the egg’s outer wall, allowing the sperm to be released into the center of the egg, where it should hopefully achieve fertilization.
By reducing the number of sperm needed to fertilize an egg to just one (although in practicality more than one sperm cell is required, just not millions), a vast number of men who were previously unable to father children – including those due to genetic causes – now have the option to. This represents a huge leap forward for the field of fertility, but it comes at a cost.
When is the ICSI treatment recommended?
ICSI is the treatment of choice if there has been a history of fertilisation failure or very poor sperm quality. ICSI can enable couples to use the partner’s sperm in cases where donor sperm would have been the only option in the past. ICSI is needed whenever sperm is obtained by surgical retrieval, such as after unreversed vasectomy.
The IVF procedure is exactly the same as for conventional IVF as far as the stimulation phase, egg retrieval and subsequent culture after fertilization . However, the big difference comes when it is time for the insemination procedure.
In most cases, we will have made the decision as to whether the insemination should be carried out with ICSI or conventional IVF well before the day of the egg retrieval. In some cases, we will leave the final decision until the day of the egg retrieval, to see which procedure appears most appropriate according to sperm quality. It is always possible that previously normal samples may look decidedly worse on the day of the retrieval, and we may opt to carry out ICSI when we would otherwise have done IVF. There is also the chance that given an appropriate sperm sample and enough eggs we will proceed with conventional IVF for some of the eggs and do ICSI for the rest.
During a conventional insemination cycle all the eggs are inseminated by adding a prepared number of sperm to the dish that they are cultured in. In the case of ICSI it is first necessary to prepare the eggs for the insemination and then check them for maturity.
When the eggs are retrieved (or in fact ovulated during a natural cycle) they are surrounded by a collection of cells called cumulus cells. These cells are an important factor in the ability of the sperm to be able to fertilize the egg, so the cumulus cells are left surrounding the eggs in a conventional insemination. However, these cells do need to be removed prior to an ICSI insemination for several reasons. The first reason is to allow direct visualization of the egg to make sure that the egg is mature enough to be injected, to position the egg to try and avoid potential damage, and to see the sperm get deposited inside the egg. It also allows the egg to be held in place while the injection is carried out to make sure that the injection is successful and removes the potential risk of introducing the cumulus cells into the egg during the injection.
The cumulus cells are removed from the egg about 3-4 hours after the egg retrieval has been carried out and then they are placed back into the incubator until it is time to perform the insemination. The injection itself is done using a high-power microscope and a pair of micromanipulators, which allow very fine control of the injection tools using joysticks – very much like video game controllers. The injection tools consist of a glass holding pipette, which has a smooth rounded opening and using gentle suction will hold the egg in place, and then an injection pipette. The injection pipette is a very fine glass needle that is used to locate, immobilize, and then pick up a single sperm. The pipette is then used to pierce the outer layer of the egg (zona) and then enter the cytoplasm, which is the main part of the egg. There is a very flexible membrane all the way around the outside of the cytoplasm, so it is important to make sure that this has been ruptured, and then the sperm can be deposited into the egg.
There is a potential for the egg to be damaged during the injection procedure, but the chance of that happening is very low, somewhere in the low single digits. ICSI is also not a guarantee that fertilization will take place even though the sperm has been deposited directly into the egg itself.
The ICSI fertilization rates are generally comparable to those seen from conventional IVF and in most cases when there are severe sperm issues, the rates are a lot higher than would have been expected without ICSI.
Other than the risk of physical damage to the eggs by carrying out ICSI, there have been some reports that show an increase in birth defects following ICSI. While the real reasons for this are not fully known, there have been several published papers that have indicated that this increase in birth defects is more likely to be connected to the sperm that is used to create the embryo rather than the ICSI procedure itself. The reason stated for this is since the male factor diagnosis has a possible genetic link, which in turn is passed onto the child. The birth defects observed are surgically correctable, such as hypospadias. Some rare genetic disorders – imprinting disorders – may be slightly more common after ICSI, such as Angelman’s syndrome and Beckwith-Wiedemann syndrome. These are extremely rare disorders, each affecting less than one child in 10,000. Most IVF clinics never see a case of these disorders, and large-scale studies are needed to determine if these disorders are truly linked to IVF or ICSI procedures or are more common due to infertility itself.
At PSFC, IVF through ICSI technique is our natural preference. The ICSI procedure has allowed countless couples to conceive. Couples that would be unable to conceive through a regular IVF insemination, due to severe male factor or other reasons, the ability to have a child of their very own. We are proud to offer ICSI, when appropriate. To learn more about the ICSI procedure and what it could mean for you please contact PSFC.
What is IMSI?
IMSI consists of the intracytoplasmic injection of morphologically selected sperm. It differs from ICSI in that sperm selection is performed under 8000x, which allows the best sperm to be chosen, significantly improving the reproductive prognosis. To perform it, a microscope with high image quality combined with complex computer software is needed, which allows the handling of the microscope from their computer.
When is the IMSI method recommended?
Applying IMSI is recommended in cases of poor sperm quality, to improve the selection of the sperm that will be used when fertilizing the egg: