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When is ICSI Used?


Intracytoplasmic Sperm Injection (ICSI)

There is a male contributing factor in approximately 47% of infertile couples. In the past, couples with moderate to severe male factor infertility had to use a donor's sperm. In vitro fertilization combined with ICSI has enabled thousands of sub fertile men to father their own, genetically related, children.

ICSI is performed in conjunction with an IVF cycle. In an IVF cycle, the female undergoes ovulation induction with follicle stimulating hormone. These medications cause her ovaries to produce numerous eggs that can be used in assisted reproductive technology procedures. Once her eggs are mature she is given an injection of hcG, or LH, and scheduled for egg retrieval.

The male partner arrives at the clinic on the day of egg retrieval and provides sperm by masturbation. This assumes that he has an acceptable quantity of quality sperm. If sufficient sperm are not available, intracytoplasmic sperm injection will be employed.

If his ejaculate is to be used for ICSI, there must be enough viable sperm so that one can be aspirated and injected into the egg. If there is not enough sperm, it can usually be obtained from the male reproductive tract. Sometimes there are no viable sperm present in the ejaculate.

When no sperm are available in the ejaculate, (or in the case of a previous vasectomy) procedures such as testicular sperm aspiration can be employed. In this procedure, sperm are withdrawn directly from the testicles. Sperm can also be obtained using microsurgical epidermal sperm aspiration, where they are withdrawn from the male reproductive tract or epididymis.

Once the sperm is aspirated into the needle, it is inserted through the egg membrane (zona pellucida). Once inside the egg, the sperm can cause fertilization, and a puncture does not damage the egg. The fertilized eggs or embryos are then incubated until mature at which point they will be transferred to the mother's uterus.


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