Intracytoplasmic Sperm Injection (ICSI)
IVF with ICSI Treatment is a procedure in which a single sperm injection takes place directly into an egg. Thus, it by-passes sperm and egg interactions involved with normal fertilization. ICSI technique is useful together with IVF to overcome severe male infertility. ICSI is a micromanipulation technique that was introduced in the early 1990’s. Since then, it’s application has been successful for the treatment of severe male infertility. To name some, suboptimal ejaculate samples, ejaculatory failure, obstructive and nonobstructive causes of azoospermia (complete absence of sperm).
Indications for ICSI:
1. Couples who have had unexplained fertilization failure in a previous IVF cycle.
2. Decreased sperm concentration, providing enough viable sperm can be recovered for injection of eggs.
3. Decreased sperm motility, including totally immotile sperm (e.g. Kartagener’s syndrome), providing sperm are viable.
4. Unusually high percentage of morphologically abnormal sperm, including round- headed sperm (globozoospermia).
5. Complete absence of sperm in the ejaculate. It can be due to an obstruction (obstructive azoospermia) caused by various conditions. The causes can be congenital absence of the vas deferens (CAVD), post-inflammatory obstruction of the epididymis or vas and failed vasectomy reversal. Fertility specialists use Testicular sperm extraction (TESE) to retrieve sperm for ICSI.
6. Complete absence of sperm in the ejaculate due to defective sperm production (non- obstructive azoospermia). Some patients may have normal sperm formation in at least some areas of the testis (identified by testicular biopsy). This can provide enough viable sperm for retrieving with TESE.
7. Ejaculatory dysfunction caused due to retrograde ejaculation (usually recovery of enough sperm from the urine) or paraplegia (electroejaculation or TESE).
8. Immunological factors; antisperm antibodies in female sera, follicular fluid or on sperm caused by vasectomy or genital tract infection.
9. Testicular cancer patients with semen samples frozen prior to treatment.
IVF With ICSI Success Rates and Risks
The ICSI procedure involves stripping cells from around the egg and injecting a needle into the egg. These procedures may damaged and degenerate (5-10%) a small percentage of eggs, often the less healthy eggs. Sometimes eggs fail to fertilize normally or arrest at an early stage of development. ICSI pregnancy rates and live birth rates are similar to those achieved with IVF. However, studies have shown that blastocyst formation is reduced compared to IVF cycles. It occurs particularly in cases of poor sperm motility and morphology. On can go with the arbitrary selection of sperm rather than relying on the natural fertilization process. Such instances has potential for increased risks of genetically abnormal embryos and birth defects including infertility.
Despite general medical acceptance by the ART community, ICSI is still a relatively new procedure. Children born as the result of ICSI are still very young and have not yet reached an age to reproduce. There are possible unknown long-term effects including those that could occur in subsequent generations.
New Findings & Reports
At this time, reports on the risk of congenital malformations associated with ICSI, compared to IVF have yielded conflicting results. A multi-center study based on data from 5-year-old children took place recently (2005). It suggests the association of ICSI with a relatively small (4.2%) increased risk of certain major congenital anomalies. There also appears to be a higher prevalence of sex chromosome abnormalities in ICSI children against those conceived with IVF (0.2% versus 1% in ICSI offspring). This can be due to the ICSI procedure itself or to an increased rate of chromosome abnormalities in sperm from some infertile men. The exact reason is not clear.
There are also some studies that report a higher incidence of a congenital malformation called hypospadias (urethra opening on underside of penis) in babies conceived through ICSI. Because some causes of male infertility are familial, and are related to genetic defects (e.g. Y-chromosome deletions) male offspring may inherit fertility problems. Therefore, patients with non-obstructive azoospermia or severe oligospermia (low sperm counts) are likely candidates for genetic causes of infertility. They should consider genetic counseling and karyotyping prior to ICSI.
In some cases, co-culture of the ICSI embryos with follicular cells collected from the follicles during the egg aspiration takes place. This provides extra nourishment and removes any embryo-toxic factors that may be present.
Fertilization Check – IVF with ICSI Treatment
What is a Fertilization Check?
A laboratory procedure performed on the day after egg retrieval. It determines which eggs have fertilized normally and can be used for embryo development and transfer.
It is important to examine the fertilized oocytes 16-20 hours after insemination to check for fertilization of oocytes (eggs). This test is important for the presence of two round nuclear structures, the male and female pronuclei (PN), formed by the sperm and egg. One must distinguish fertilized oocytes (“zygotes”) from the unfertilized and abnormally fertilized oocytes. At this point, carefully dissecting away the Cells surrounding the eggs allows clear visualization of the egg. Pronuclei must be scored within the appropriate time span, before they merge and are no longer visible (during a phase called “syngamy”). This ensures culturing or cryopreserveation of only the normal zygotes with two pronuclei (2PN’s) for embryo transfer.
Observation of abnormally fertilized oocytes takes place when eggs undergo development without fertilization (1PN) or are fertilized by two (or more) sperm (3PN). Such abnormal oocytes cannot be used for attempting to initiate a pregnancy since they are genetically abnormal.
Embryo Grading and Selection for Transfer
What is Embryo Grading?
Assigning a grade to each embryo to identify the best quality embryos. These are then selected for embryo transfer or cryopreservation.
Selection criteria or grading systems must be applied for all cleavage stages from day 2-4. It takes place to allow selection of the most viable embryos. Evaluation of embryo development takes place approximately every 24 h. Slow dividing, nondividing (arrested) or fragmenting embryos are selected. Compacting embryos on day 3 that have closely apposed cell membranes are selected.
The quality of each embryo is assessed using the following grading system:
A Grade: Even, equally sized spherical cells (blastomeres) with no cellular fragmentation.
B Grade: Embryos have uneven or irregularly shaped blastomeres and less than 10% fragmentation of blastomeres.
C Grade: Embryos have up to 25% fragmentation. Blastomeres appear viable (although may be granular).
D Grade: Embryos have 25-50 % fragmentation. Blastomeres appear viable (although may be granular).
E Grade: Embryos with lysed, contracted or dark blastomeres are considered non-viable.
In selecting embryos for an embryo transfer, one normally chooses the most viable embryos. These are the embryos that are rapidly (or normally) dividing with little if any fragmentation. Therefore, those embryos that have reached the most advanced developmental stage and have the least cellular fragmentation (Grades “A” and/or “B”) go into selection for transfer. Blastocysts selection for transfer takes place based on a few factors. Such as the rate of cell division, cavity expansion and formation of the inner cell mass (the central embryonic portion).
Cytoplasmic Transfer involves the injection of a small amount of cytoplasm (the viscous semi fluid inside an egg). Your fertility specialist will take it from a donor egg and put it directly into your patient’s eggs. The transferred cytoplasm is to contain components missing or abnormally functioning in the recipient egg. The aim of cytoplasmic transfer is to overcome any deficiencies. Such deficiencies may exist in the cytoplasm of an egg while retaining the patient’s genetic material.
Early studies on cytoplasmic transfer in the monkey took place. It demonstrated that transfusion of cytoplasm from a mature egg into immature eggs conveyed developmental competence to some immature eggs. The cytoplasmic factors transferred may be specialized proteins or messenger ribonucleic acid (mRNA). Sometimes it can be mitochondria – units that generate energy for the egg which may enhance the quality of embryos. Unlike embryos from donor eggs, the embryos produced from cytoplasmic transfer carry the mother’s genes.
This procedure is particularly suitable to patients that have a history of poor embryo quality (i.e. fragmentation, slow cleavage or arrested development) and failed implantation, but who make a reasonable number of eggs. Patient’s are typically in their 30’s. The procedure is usually not recommendable for women over 40. It is because, the main reason of implantation failure at this age is a genetic abnormality (for example, a missing or extra chromosome). The cytoplasmic transfer does not alter the genetic makeup of the egg (nucleus).
The procedure works combined with ICSI. Thus, an immobilized sperm injection takes place along with the donor cytoplasm. The amount of cytoplasm used for injection of one egg is only about 5% of the volume of the donor egg. Given that, each donor egg may be used for several recipient eggs. It is possible to fertilize excess donor eggs with the partner’s sperm and use it for embryo transfer. It is an option in the event when there are not enough good embryos from the patient’s eggs, or cryopreserved (of course, these will have the egg donor’s genetic material).
The report of the first human pregnancy following cytoplasmic transfer came up in 1997. For this procedure, oocyte donor and patient undergo simultaneous stimulation. Reports of success recently surfaced using cytoplasm from cryopreserved donor eggs while eliminating the need for synchronization between donor and patient. However, further studies are needful to determine whether the transfer of frozen material is as beneficial.
ICSI Treatment Facility with RSMC, San Diego
View also our information in the lastest ICSI Research papers.
Our fertility specialists at The Reproductive Sciences Center, or RSC, are conveniently located in La Jolla California in San Diego County. We have worked hard to create and maintain our reputation as the first-rate San Diego fertility clinic and sciences center. RSC has become synonymous with comprehensive and successful female and male infertility treatment, egg donor programs, and surrogacy options, in vitro fertilization, ICSI and more.
Extended Services World Wide
We have provided services to hundreds of patients throughout the Temecula, Murrieta, La Jolla, Riverside, San Bernardino and Encinitas areas. apart from that, we also help many people from across the United States, Europe, Australia , Asia, Africa and the Americas who make us their final destination for IVF with ICSI Treatment in San Diego. We lead the area as one of the leading fertility centers in the world.
Our Experience & Reputation
Our fertility center has long established itself as having one of the highest fertility success rates in the world. With more than 75 years of combined medical training, experience, and ongoing continuing education, our fertility specialists set the bar for the industry. Our medical director and leading fertility doctor is one of the most well-respected experts in the world.
Successful IVF with ICSI Treatment in San Diego is only possible with the best fertility specialists and staff in Orange County. We have been providing IVF with ICSI Treatment for infertility in San Diego.
Range of Fertility Treatment
Some of our successful options for IVF with ICSI Treatment in San Diego include natural fertility treatment, advanced fertility treatment, IUI (Intrauterine Insemination), Customized In Vitro Fertilization (IVF), or IVF with ICSI Treatment for severe male infertility, genetic testing, embryo donation, blastocyst transfers, assisted hatching, and more. We are the top professionals of fertility options for women with cancer and fertility options for men with cancer in San Diego as well.
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