How Is Icsi Performed

The ICSI procedure refers to the process of how the sperm fertilizes the egg and is typically performed in conjunction with another ART, such as IVF. The remainder of the steps are usually identical to IVF or another ART technique that your doctor may recommend.

Because most of the time ICSI is performed in conjunction with IVF, the steps of these procedures are almost identical.

• Ovulation stimulation

• Egg retrieval

• Sperm collection and preparation

• Fertilization

• Embryo monitoring

• Embryo transfer

• Follow-up after ICSI

• Cryopreservation after ICSI

Ovulation stimulation and egg retrieval follow the same steps as in the IVF procedure.

Sperm Collection and Preparation

The sperm used during your ICSI procedure almost always comes from your partner as opposed to a sperm donor. After all, the primary purpose of ICSI is to assist men with severe male fertility issues. So even if your partner has very poor sperm quality or quantity, his sperm are often still used successfully.

As with most other techniques, sperm are usually obtained via masturbation and ejaculation. If that is objectionable to you or your partner for religious or other reasons, talk to your doctor about a special condom that may be used to collect sperm during intercourse.

The laboratory needs the semen specimen within a few hours after egg retrieval. The fresh semen is taken to the laboratory, where it is washed, concentrated, and specially treated so each healthy sperm has the best potential to successfully fertilize your eggs. Sometimes in the case of severe male fertility problems, sperm cannot be obtained through masturbation or sexual intercourse. In this situation, sperm can sometimes be captured with direct testicular biopsy.

Sperm Aspiration. Sometimes sperm can't be collected with routine methods of masturbation or a special collection condom during sexual intercourse. This may be because of an abnormality of the male reproductive tract that your partner was born with or the result of a serious injury. It may also be the case with men who have had a prior vasectomy. New microsurgical techniques have been developed to obtain the sperm directly from either the testicles or the epididymis when it cannot be collected by the usual methods.

• Testicular sperm extraction (TESE): Sperm can be directly obtained from the testicles using a special testicular biopsy technique. A very small piece of testicular tissue is taken to the laboratory, where sperm are extracted and evaluated.

• Microsurgical epididymal sperm aspiration (MESA): Sperm can be directly obtained from the epididymis using a specialized needle collecting system. You'll recall that the epididymis is a thin, hollow coiled system within the scrotum that receives the maturing sperm from the testicles. The fluid from the epididymis is collected and then sent to the laboratory, where sperm are removed and evaluated.

The emergence of these techniques has been of great benefit for male fertility problems. Men who could not use their sperm in the past are now able to do so with these specialized procedures. The collected sperm can be used in various ART procedures. With these important microsurgical techniques, men who thought they would never be able to father a child are now able to do so.

Fertilization

Your collected eggs will be examined in the laboratory and will be specially treated to remove the surrounding membrane, thereby making the egg easier to penetrate and fertilize.

Each egg is held in place with a specially designed instrument, and one sperm is injected into each egg's center. The inseminated eggs are then placed in an incubator and checked the next morning to determine which have successfully fertilized. The fertilized eggs are left in the incubator to continue to grow and develop into embryos for the next day or two.

The next steps—embryo monitoring, embryo transfer, follow-up, and cryopreser-vation—are the same as those in the IVF procedure.

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