ICSI (Intra Cytoplasmic Sperm injection) is a very specialised laboratory technique. With ICSI, a single sperm is injected with a micro-needle directly into the egg.
The ICSI method does not guarantee fertilisation of the egg – the sperm must still perform the necessary biological processes to fertilise the egg successfully. The decision on which method to be used will be discussed with you before treatment starts and will depend on several factors, like diagnosis, history and other specific indications.
It can also be decided by the embryologist and/or the doctor on the day of the aspiration to change the insemination method if there are indications to do so (e.g. number of eggs, egg quality and sperm sample quality). This will be discussed with you.
The fertilisation rate (how many of the eggs fertilise) cannot be predicted. Sometimes some of the eggs do not fertilise and, very rarely, none of the eggs may fertilise. Reasons for fertilisation failure cannot always be established, but in these cases ICSI would usually be suggested in the next treatment.
On the day:
You will be admitted into the day ward at Wijnland Fertility. The aspiration procedure is very short and makes use of anaesthesia sedation, which means that you need to be prepared prior to the day of the procedure (no eating after midnight). The aspiration procedure is so short (generally), that the process of the anaesthetist putting you ‘to sleep’ takes longer than the actual egg retrieval. Once your procedure is finished, you will be wheeled out of theatre and be placed back into your warm recovery bed where you will be woken up with some tea or coffee and a scone. Thereafter, an embryologist will let you know how many eggs where retrieved. This information is only given to you once you have fully woken up from your drowsy sleep and are relaxed and ready to receive the much awaited information.
Following the egg retrieval:
The eggs will be evaluated the next day to see how many have been fertilised (Day 1).
We will call you to inform you of the results. Fertilised eggs are now known as zygotes and can start to develop into embryos.
Not all fertilised eggs develop into embryos, but most do. The quality of the embryo development will be evaluated by a scientific grading system, which will guide us to select the embryos with the greatest implantation potential to place into the uterus. The embryologist will inform you of embryo development.
The Embryo Transfer The embryo transfer procedure will be done on Day 5 (in standard cost option Day 3), depending mainly on how many good-quality embryos have developed. Our clinic’s protocol is to transfer only one embryo per cycle. In exceptional cases, two embryos may be transferred at the discretion of the treating doctor and attending embryologist. It will depend largely on the quality of the embryos. If any surplus high-quality blastocysts remain in culture after the transfer, they can either be frozen and stored for future use, or donated or discarded.
Please talk to the doctor and/or embryologist about the freezing, discarding or donation of surplus embryos before starting fertility treatment to ensure you and your partner have enough time to think about these options and make a well-informed decision. The nursing sister or embryologist will call you to inform you when the transfer procedure is going to take place.
You will be given information about preparing for the transfer procedure. This will also include having a full bladder. You will be conscious, and your husband/partner can be with you in the procedure room. Your uterus will be visualised by doing a trans-abdominal scan and the doctor will use a speculum to visualise the cervix. The embryos will be drawn into a thin catheter and will be placed into the uterus.
The embryos will be released slowly into the uterus – you and your partner will be able to see this on the ultrasound screen! Your bladder will then be emptied by the doctor with the use of a catheter. You may lie down and rest for a short while after the transfer. If you have any surplus embryos in the laboratory, the embryologist will talk to you about your decision and/or instructions on the handling of your surplus embryos. The embryologist will give you the applicable consent forms to be signed by you.
You will also receive forms showing a summary of the number of eggs retrieved, the number fertilised, how many embryos were transferred, how many were left in culture and when pregnancy tests can be done. You can then go home and continue with your daily activities. We advise you to take it easy on the day of the transfer. You may drive a car if needed. The embryologist will phone you a few days after the transfer to give you feedback on the further development and/or freezing of your surplus embryos, where applicable.
We recommend ICSI to patients who have had:
Q: Will all of our eggs be injected?
A: We aim to optimize each cycle to give patients the best chance at pregnancy. The embryologist will make every effort to inject as many eggs as biologically possible (mature eggs) on the day of insemination. It is important to note that only mature eggs can be injected with sperm to give the egg the best chance at fertilizing. In the case of immature eggs on the day of injection, we can culture them overnight to give the eggs the opportunity to mature by the next morning. Embryologists can inject the late-matured eggs the next morning, but it is important to understand that not all eggs will mature overnight, and that late-matured eggs are of poorer quality.
Q: How successful is ICSI?
A: The fertilization rate of ICSI is case dependant, as both the egg and sperm play a big role during fertilization. The average fertilization rate of mature inseminated eggs using ICSI is up to 85%. Please look at our success rates here
Q: Who should consider split ICSI?
A: Split ICSI is an option which we usually offer to patients with a normal sperm sample and good morphology parameter. The other requirement for this option is to have a minimum number of mature eggs, which the fertility specialist will determine. If there are very few eggs, we will most probably not suggest this and only inject the eggs via ICSI. This treatment entails injecting half or more of the eggs through ICSI and inseminating the other half or more with sperm to fertilize the eggs without any external intervention. The principal of this option is to create a “safety net” against failed IVF fertilization with the standard sperm insemination. The cost of this option is the same as doing a full ICSI only cycle.
Q: How does ICSI differ from standard IVF?
A: Conventional IVF entails adding sperm into the culture dish with the eggs, to allow the sperm to penetrate and fertilize the egg on its own. ICSI entails the selection of one sperm and injecting it into the egg using micromanipulated needles. Therefore, ICSI bypasses the egg-sperm barrier and eliminates the possibility of failed sperm penetration through the membrane of the egg.