The intracytoplasmic sperm injection (ICSI) is an assisted reproductive technique introduced in the 90s and came to success by solving the most serious problems of male infertility. ICSI is similar to the conventional in vitro fertilization, with the difference that the insemination is done directly by an embryologist by means of the introduction of a sperm cell in each oocyte with a micro-needle.

The sperm used for micro-injection can result from the partner (homologous ICSI) or by a sperm bank(heterologous ICSI).

To perform this technique and to ensure acceptable success rates, an ultrasound must be done of the uterus to exclude deformaties that can influence implantation and pregnancy development. Furthermore, we need to ensure a good response to the ovarian stimulation, in order to obtain sufficient oocytes for the performance of the technique.

When

Male infertility:

  • Oligozoospermia or cryptozoospermie: strong decrease in sperm count.
  • Asthenozoospermia: severe reduction in the motility of the sperm, including sperm with a total absence of mobility.
  • Teratozoospermia: high number of abnormal sperm.
  • Obstructive azoospermia: complete absence of sperm in the ejaculate due to a blockage. The most common causes are genetic or inflammatory or failed vasovasostomy.
  • Secretory Azoospermia: complete absence of sperm in the ejaculate due to a defect in sperm production in the testicles.
  • Anejaculation: ejaculatorie disorder or retrograde ejaculation caused by a spinal cord injury.

In the case of azoospermia and anejaculation one can get the sperm cells that are needed or the ICSI treatment directly from the testicles (testicular biopsy or puncture).

  • Immune Cause: the presence of a large number of antibodies.
  • Valuable semen samples: patients freeze sperm before undergoing chemotherapy or radiotherapy, or which was required by the development of infectious diseases (HIV, hepatitis) or the use of donor sperm.

Female infertility:

  • Obtaining a low number of oocytes in follicular puncture.
  • Poor quality of oocytes in general, including thickened pellucide zone.
  • Long term infertility (more than two years in the search of a pregnancy).
  • Performing multiple cycles of targeted coitus, artificial insemination and / or conventional IVF without success.
  • No fertilization with conventional IVF in a previous cycle.
  • Microinjection of oocytes after conventional IVF without fertilization.
  • Oocyte maturation in vitro.
  • Conducting pre-implantation genetic diagnosis (PGD).
  • Microinjection of vitrified oocytes.

Phases

The steps in ICSI are the same as in conventional IVF, with the difference that the insemination of the oocytes is achieved by the introduction of a sperm into each mature oocyte obtained by means of a micro manipulator and micro needle.

Ovarian stimulation
We begin treatment with ovarian stimulation, where we use a number of hormones similar to those produced by the woman herself (gonadotropins). The goal is the development of multiple follicles to abtain a high numer of oocytes and thus increase the chances of success. The stimulation is regularly monitored by ultrasound and blood tests.
Ovulation induction

After several follicles have reached the right size (18 mm diameter) HCG hormone is administered to trigger final oocyte maturation, which will occur after 34-36 hours and that is when will be performed the follicular puncture.

Follicular puncture
Under sedation, the fertility specialist removes mature oocytes by follicular puncture and vaginally. The oocyte retrieval is a minimally invasive procedure that normally takes less than 15 minutes. Generally, patients can resume normal activities the next day.
Sperm capacitation
On the day of follicular puncture, the andrology laboratory has prepared the semen sample (seminal training) by previously selecting sperm washing techniques with greater motility.
When using a semen from a sperm bank we will proceed to the thawing of the sample and the training.
Insemination of oocytes
Depending on the alterations or chromosomal genetics to be analyzed and / or semen quality we will proceed with the insemination of oocytes by conventional IVF or ICSI.
Fertilization and embryo culture
The day after insemination, fertilization is observed in the oocytes. Those who have been properly fertilized will be kept under observation in the laboratory for several days (between 2 and 5 days). Day after day we will be watching the embryos dividing and increasing its number of cells.
Embryo transfer
Embryos that have, after genetic analysis, normal genetic and chromosome endowment and / or adequate morphological characteristics will be trasferred to the womb, and if there are healthy embryos leftover we will proceed to freeze. The day of the transfer we will decide the appropriate number of embryos to be transferred, those can not be higher than three per cycle. The gynecologist uses a small catheter to guide the embryos through the cervix and deposit them. The embryo transfer procedure lasts a few minutes and the recovery time for the patient is minimal.
Luteal phase support
To facilitate embryo implantation progesterone is administered vaginally to help support the luteal phase.
Pregnancy test

The pregnancy test will be done trough a blood test 13 days after the follicular puncture.

If the patient has lost blood before undergoing the test it is important to never leave the medication and to contact the medical team for advice. Throughout treatment, your personal assistant will be available at all times to resolverle doubts that you may have and support you in this special moment.

Fertility clinics in Spain

Medical Team

Susana Sempere - Gynaecology

Dr. Susana Sempere Ferri

Antonio Moya - Reproductive Medicine

Dr. Antonio Moya

Eva Moreno

Dr. Eva María Moreno Ruiz

Jose Manuel Lozano - Gynaecology

Dr. Jose Manuel Lozano

Romina Ramírez - Gynaecology

Dr. Romina Ramírez Melguizo

You know what…

  • The first ICSI pregnancy was achieved in 1992.
  • In Spain, about 80% of cases are solved by ICSI and 20% by conventional IVF.
  • The chances of success are the same as for conventional IVF. Keep in mind that the results of the most influential factor is the age of the woman. Overall, the pregnancy rate is around 30-40% per cycle in women under 38 years. Above the age of 40, the percentages are significantly lower (10-15%).
  • Usually after the transfer, the patient waits about an hour in the room of the fertility clinic. If your gynecologist does not indicate it there is no rest needed after the transfer. There are no studies showing that rest increases the chance of pregnancy. Then, once home, they can carry out their normal life.

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