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Intracytoplasmic sperm injection (ICSI)
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Microinsemination, also called Intra Cytoplasmic Sperm Injection (ICSI), is an advanced form of IVF treatment. In microinsemination, the woman has eggs retrieved. A single sperm cell is then taken and inserted directly into the woman's egg under a microscope. The method has been used since 1992 and differs from conventional IVF treatment, where eggs are fertilised by adding many sperm cells to each egg.
When is ICSI used?
ICSI is used in these cases:
When the man's sperm quality is very low - that is, very few live sperm and/or mobile sperm
If the sperm has been removed from the testicles (TESA)
If very few or no eggs have been fertilised in previous IVF treatments
A new sperm purification system may increase chances of pregnancy
TFP Stork Fertility is the only clinic in Denmark to offer MACS ART
DNA fragmentation (errors in the DNA chain) of sperm has long been talked about as a major problem in fertility treatment, as these sperm cannot lead to pregnancy. Lifestyle changes such as smoking cessation, weight loss, more exercise, vitamin and mineral supplements etc., will have been recommended, after which improved sperm quality would have been seen after 4-6 months. Thus, the couple looking to conceive would not be fertile straightaway, but would have to wait for the effects of the lifestyle change to kick in.
The purification system MACS, ART Annexin V Microbeads is used to remove sperm cells with a high proportion of fragmented DNA (elevated DFI index) that are undergoing apoptosis (cell death). The method is used for stem cell purification in several university hospitals. MACS purification is used immediately before fertilisation of the woman's egg, and can thus remove the apoptotic sperm cells. Studies have shown an increased pregnancy rate of 3-5% with IVF treatment and up to 15% with ICSI treatment. The method should be used primarily for couples who have had a long fertility cycle with several treatments without pregnancy.
How ICSI works
1. The woman receives hormone treatment
In ICSI or IVF treatment, it is important to have several mature eggs. The woman therefore receives hormone treatment to mature more eggs at the same time.
2. The woman goes for egg retrieval
Once the eggs are mature, the woman goes for an egg collection. The procedure takes about 20 minutes in total. With the help of ultrasound, the eggs are sucked out through a fine needle, which is inserted into the ovary. After egg retrieval, the eggs are taken immediately to the laboratory where they are prepared for fertilisation.
3. The semen sample
The man gives a sperm sample at about the same time as the woman comes for egg collection. The sperm then has to be purified in the laboratory to obtain as many good quality sperm as possible - otherwise the laboratory will dry up the woman or couple's chosen donor sperm.
4. Fertilisation and egg culture in the IVF laboratory
In the laboratory, sperm are selected and introduced into each egg. This is done under a microscope using a glass cannula. Once fertilised, the eggs are placed in an incubator - a sophisticated 'incubator box'. The following day, we can see how many of the eggs have been fertilised. Over the next few days, we can follow the further development of the embryos. The eggs stay in the incubator for 5-6 days.
5. Inserting the fertilised eggs
The fertilised egg is inserted in the uterus. This takes only a few minutes and the embryos must now attach to the lining of the uterus and further develop. After about 14 days, the woman can take a pregnancy test to find out if the ICSI treatment was successful.
Risks of microinsemination?
A doctor will go through all the risks in a personal consultation before starting the treatment. We take great care to minimise all risks associated with IVF and ICSI - including the development of so-called overstimulation syndrome.
Some women respond more strongly than expected to hormone treatment and therefore produce many egg follicles. Symptoms include abdominal bloating and pain, as well as mild nausea and shortness of breath. Symptoms disappear within a few days.
There is a risk of unintentional organ damage or bleeding during egg collection. After egg collection, there is a risk of infection, which will manifest as fever, pain or foul-smelling discharge.
In ICSI treatment, we usually only retrieve one fertilised egg at a time. This is to reduce the risk of multiple pregnancies (i.e. twins/triplets).
Chances of pregnancy with ICSI treatment?
The chance of getting pregnant with ICSI depends mainly on the age of the woman. In women aged 30-39, about one in three treatment cycles results in pregnancy.
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