ICSI: Intracytoplasmic Sperm Injection

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The Intracytoplasmic Sperm Injection (ICSI), consists in the introduction of a single spermatozoid inside a mature egg to achieved fecundation. Undoubtedly, is the assisted reproduction technique (ART) most use and it meant a revolution in the early 90s, as it came to successfully solve the majority of the sterility problems cause by the masculine factor.

Due to its high and constant exit rates to achieved fertilization, the ICSI technique has not substantially changed since the beginning. The necessary equipment consists of an inverted microscope, with a specific optic (Hoffman) and a heated plate (37¼). Micro-handles are attached to this microscope allowing us to make three-dimension movements with the micro-pipettes that hold the egg and contain the spermatozoid. The sperm motility as well as the experience of the embryologist that performs the technique are the two most important factors to guarantee the effectiveness of the technique.

The sperm selection techniques previous to preforming the ICSI have evolved in the last few years allowing us to carry out a more specific selection. Nowadays we can carry out a morphological evaluation choosing the spermazoid that are going to be microinjected with special optics that allow its vision with over 6000 magnifications (IMSI). It can also be carried out what is called Òphysiological ICSIÓ where hyaluronic acid is used in the micro-injection plate or in the culture medium (ÒSperm SlowÓ) to select the mature spermatozoids which, a priori, present a reduction in chromosomal imbalance. However, recent studies have not shown the supremacy of those methods and are still in an experimental stage.

The use of annexin columns type MACS previous to the ICSI technique also allow us to select pre-apoptic spermatozoids, which will go into a programmed cellular death and could not give place to ongoing embryos. These columns are also used in cases where an excessive spermatic DNA fragmentation, which is related to fertilization failure cases and embryo blockage.

ICSI treatment in Spain

The indications to carry out an ICSI technique has to be supported in a thorough fertility study to the couple and could be the following:

1. Masculine sterility:

  • Oligozoospermia or cryptozoospermia: severe reduction in the number of spermatozoids.
  • Astenozoospermia: severe reduction in the sperm mobility, including samples with no mobility at all.
  • Teratozoospermia: high number of abnormal spermatozoids.
  • Obstructive azoospermia: complete absence of spermatozoids in ejaculation due to an obstruction. The most common causes are of genetic or inflammatory origin or failed vasovasostomy.
  • Secreted azoospermia: complete absence of spermatozoids in ejaculation due to a defect in the testicleÕs spermatozoids production.
  • Anejaculation: ejaculation dysfunction caused by retrogressive ejaculation.
    In the azoospermia and anejaculation cases, the necessary spermatozoids for ICSI technique can be obtained directly from the testicle (testicular puncture or biopsy).
  • Immune cause: presence of high number of anti-spermatozoids antibodies.
  • Valuable sperm samples: patient who have frozen sperm samples before going under chemotherapy or radiotherapy, those who require the sperm to be ÒwashedÓ for suffering infectious illnesses (IVH, hepatitis) or the use of donorÕs sperm.

2. Female sterility:

  • A very low number of oocytes obtained in the follicular puncture. Although in those cases a conventional IVF can be performed.
  • General Low oocyte quality, including the swollen pellucid membrane area.

3. Other causes:

  • Long term sterility (more than two years looking for pregnancy)
  • Several unsuccessful timed intercourse or artificial insemination cycles.
  • No fertilization in a previous conventional IVF treatment.
  • Rescue microinjection: oocyte microinjection after failed conventional IVF.
  • In Vitro oocyte maturing..
  • No pregnancy achievement after several conventional IVF cycles.
  • Performing pre-implantation genetic diagnosis (PGD).
  • Vitrified oocytesmicro-injection.

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