Intracytoplasmic Sperm Injection - ICSI. Indications, the procedure - ICSI photos - Methods of sperm retrieval which are used for ICSI

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Specialized tools and inverted
microscopes
Pick up a sperm using a specialized
ICSI needle Advanced through the egg
membrane
The sperm is injected into the inner
part of the egg (the cytoplasm).
Then fertilization occurs in 75 - 85%
of eggs injected with sperm.

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Male infertility factors that includes low sperm counts, poor motility or movement of the sperm,
poor sperm quality, sperm that lack the ability to penetrate an egg or azoospermia.
Failure of fertilization in previous IVF attempts.
If the male partner underwent a vasectomy and sperm have been collected from the testicles or
epididymis.
If male partner has problems in erection or ejaculation.
It is used for couples with a small number of eggs at egg retrieval, to get a higher percentage of
eggs fertilized than when mixing eggs and sperms together in the IVF procedure.

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 Stimulation Of Ovaries
 Collection Of Eggs by hollow needle & ultrasound guidance.
 Sperm Picking by delicate needle.
 Transferred to the uterus 2 to 3 days after fertilization.
 Pregnancy test should be done 2 weeks after the embryo transfer.

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Methods of sperm retrieval for I.C.S.I
 If there were sperm in the semen, a sperm sample can be produced by
normal ejaculation into a cup on the same day of egg collection.
 If there is no sperm in the semen, the doctor can extract sperm from the
male partner under local or general anesthesia.
Percutaneous Epididymal Sperm Aspiration & I C S I (P.E.S.A , M.E.S.A)
It is only required if the husband has one of the following problems:
 Absence of the vas deferens (through which the sperm passes from the
epididymis to the seminal fluid ).
 Past Infections that result in obstruction.
 Cases who have had a vasectomy and surgical reversal failed.

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Testicular Sperm Aspiration & I.C.S.I (T.E.S.A, T.E.S.E)
 Obtaining sperm directly from the testes, either by
aspiration, using a needle or surgical extraction
 The sperm are then used to do the ICSI procedure as described
above.
This method is used in the following cases:
 Absence of sperms in the epididymis.
 Absent or obstructed epididymis.
 TESE might be done before the beginning of the treatment
cycle and the collected sperm are then frozen.

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 The risk of multiple births and ectopic pregnancy.
 The risk of congenital abnormalities.
 There is an increased risk of genetic problem carried by the sperm.
 ICSI is more expensive than IVF.

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