Intra Cytoplasmic Sperm Insertion (ICSI) is a procedure by which a single sperm is inserted with the aid of a micro needle into the cytoplasm of a mature oocyte. This procedure is recommended for severe cases of male factor infertility or previous fertilization failure in IVF

ICSI (Intracytoplasmic sperm injection)

Steps:

  • Controlled ovarian stimulation
  • Oocyte retrieval and semen preparation
  • ICSI
  • Check Fertilization
  • Check embryo cleavage
  • Extended culture, if possible
  • Luteal support
  • Pregnancy test
  • Clinical pregnancy
  1. COS 

blank

The two most commonly used protocols in the world are

  1. Midluteal long protocol
  2. Antagonist protocol

The choice of protocol for ICSI is variable from one patient to the other. In Rahem Fertility center, we tailor the optimal stimulation protocol, according to age, ovarian reserve, BMI and previous response. Our early study (published in the journal of American Society of Reproductive Medicine) about anti-mullerian hormone (AMH) was among the earliest studies in the world reporting the superior advantage of this hormone for early and accurate prediction of OR.

* We strictly follow our patients using transvaginal ultrasound and estradiol levels during COS

* When follicles mature, we trigger ovulation.

 2- Oocyte retrieval and semen preparation: On retrieval day, semen sample is taken from husband (fresh and/or frozen) and prepared to take the best sperm.

3- ICSI: The mature oocytes (after removal of surrounding cells) are injected one by one using a glass holding pipette to secure the egg and a very small micro needle through which the sperm is inserted

4- Check Fertilization: After 16 – 18 hours, we check Fertilization (evidenced by appearance of 2 PN and 2nd polar body)

5- Check embryo cleavage : on 2nd to 3rd day to check embryo quality

6- Extended culture: if we have 3 good quality embryos on day 2-3, we consider extended culture to day 5. We donot extend culture if we donot have these criteria. The latest high quality evidence (Cochrane review 2013) report increase cancellation of embryo transfer if we do extended culture for all patients irrespective the quality of cleavage embryos.

7- Luteal support: we start on day of retrieval for 15 days

8- Pregnancy test: 15 days after embryo transfer

9- Clinical pregnancy: we diagnose that with appearance of cardiac pulsations 2 weeks after positive pregnancy testblank

Sperm is injected inside cytoplasm