ICSI is the abbreviation of Intracytoplasmic Sperm Injection. This technique allows us to choose the best sperm to insert it inside a microinjection needle.
Then, while the oocyte is being held from one side, the needle is carefully inserted in the opposite side, so that the sperm is injected into the cytoplasm of the egg.
The goal is that the egg and sperm fuse together. In other words, that fertilization takes place successfully.
What is ICSI used for?
ICSI is used when the male’s sperm cells have trouble penetrating the egg by themselves. Although it is usually done with the husband’s or partner’s sperm, donor semen samples can be used as well.
Nonetheless, ICSI is the method of choice also in the case of couples who turn to IVF without a pre-existing severe cause of male infertility in order to make sure that fertilization occurs.
The following are some of the most important indications for ICSI:
Azoospermia
This male fertility problem occurs when the sperm count in the ejaculate is zero. There exist two types of azoospermia:
Obstructive azoospermia: The sperms are prevented from mixing with the remaining seminal fluid due to a blockage in any of the ejaculatory ducts. Sperm production occurs, yet the sperms are not expelled.
Non-obstructive azoospermia: No sperm is produced, as the problem remains in the testes, which is the location where spermatozoa are created
Oligozoospermia
It refers to poor sperm quality caused by the absence of sperm concentration in the ejaculate. The WHO (World Health Organization) uses a cut-off of not less than 15 million sperm per milliliter as a general recommendation.
Asthenozoospermia
Also known as asthenospermia, this parameter measures sperm quality according to how motile they are. In accordance with the WHO, this pathology is diagnosed whenever the amount of progressive spermatozoa or able to move forward is less than 32%.
Also, the total count of motile sperms should be above 40%.
Teratozoospermia
Teratozoospermia or teratospermia refers to a problem in sperm morphology. According to the Kruger strict criteria, the presence of more than 85% abnormal sperm in the ejaculate indicates male sterility. In these cases, ICSI is the most advisable treatment to achieve parenthood.
If the WHO’s criteria is followed, then a semen sample is considered to have teratospermia if more than 96% of sperm are morphologically abnormal.
Several abnormal sperm test values
In addition to the above listed sperm pathologies, it is possible for various sperm values to appear altered in the semen analysis.
Taking this into account, the following combinations are possible:
Other indications
ICSI is also advisable after vasectomy or in males diagnosed with an infectious disease (HIV, hepatitis, etc.).
Males who have had their semen cryopreserved due to cancer treatments (radiotherapy or chemotherapy) or those unable to ejaculate under normal conditions are recommended to undergo ICSI as well.
ICSI is not so common in cases of female infertility. It is used in cases where a scarce number of oocytes have been obtained after ovum pick-up, if there is an enlargement of the zona pellucida, or in women producing poor-quality eggs.
Nevertheless, this is a controversial issue. Many specialists argue that, in cases where the eggs are more fragile, classical IVF is more advisable because the level of manipulation of the eggs is less aggressive.
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