ICSI (Intra Cytoplasmic Sperm Injection)
Normally during every mid-menstrual period, one of the 2 ovaries releases an ovum. Each ovum is covered by a membrane called follicle, which is filled with a fluid. Thin follicle ruptures and releases the ovum- which is called ovulation. This ovum travels through the fallopian tube with the help of hair like structures called cilia and reached the uterus.
After sexual contact millions of sperms reach the vagina, but only about 2000 sperms survive and reach the fallopian tube. If an ovum is present in the tube, they undergo fertilization. Sperm can stay alive for 3 days in the tube. Sperm penetrates the wall of the ovum. Only one sperm can penetrate, remaining are destroyed. Such a fertilized Embryo ( ovum+ sperm) splits into 2. In 72hours this embryo becomes 64 cells. The fertilized egg around 5th day reaches the uterus, sticks on to the uterine walls- this is called nidation. Success of nidation means pregnancy.
What is IVF?
During normal menstrual cycle instead of one follicle many follicles are stimulated by hormone injections. With the help of scan these follicles are taken out, mixed with husband’s sperms and resulting embryo is kept back into the uterus.
What is ICSI?
This is an ideal method for these with low sperm counts. Centrifuged and healthy sperm is injected in to each ovum using a micromanipulator. This is ICSI.
Who needs ICSI?
• Women with absence of fallopian tube (following tubectomy- sterilization block in the tube (due to adhesions- infections).
• Male factor  – unhealthy sperms
– Obstruction in the track of sperm movement
– Absent Sperms
– Failure to ejaculate
• Female Factors
– Failure to ovulate
– Endometriosis – Adhesions around uterus
What are the steps of ICSI?
• As more numbers of follicles are needed for the procedure hormonal injections are given 20- 26 days prior to the ovum retrieval.
• After 14 days of injection scan is done, along with blood hormonal evaluation. As per the follicle growth on scan the close of hormone injections are tittered.
• Once the follicles are fully matured HCD injection is given 36 hrs following which the ovum is taken out using ultrasound scan transvaginally. Patient discharged after few hours.
• Same day sperm is collected.
• Healthy sperms are separated and injected into ovum using advanced equipments and the resulting embryo (usually after 2 days) is kept back into uterus.
• After this progesterone injections are given to support implantation.
• This is followed by embryo growth.
• Blood is tested for pregnancy hormone after 13 days.
• Extra embryos are frozen for future use.
• All these steps are out- patient procedure
Reasons to Stop the Treatment
• Failure of follicles to grow in spite of injections
• Too many follicles grow at same time.
• Follicles with no ovum.
What is the Success Rate?
Pregnancy rate is 60-70%. But taking into account the abortions, tubal pregnancy, biochemical pregnancy- the take home baby rate is 40%.
How is ICSI pregnancy different from Normal Pregnancy?
There is NO difference in between these pregnancies. Babies born through ICSI show no difference in growth or school performance or health from normal pregnancy.
January 8, 2015

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