ICSI

Indications and results

Intracytoplasmic Sperm Injection

 Is a form of IVF (‘IVF with ICSI’)

 Male factor infertility
• Oligozoospermia
• Azoospermia
• Sperm motility problems
– Epididymal and testicular sperm (non-mature and
non-motile) PESA, MESA, MESE
– Cogenital BAVD (ciliary defect)
 Repeated failed standard IVF
 Changing indications : some labs now only offer ICSI. Most still
offer IVF or IVF with ICSI
Genetics
 Karyotype analysis is essential in
– severe oligozoospermia (6-7%)
– azoospermia (15%)
• mutations in the long arm of the y chromosome
Yq in the AZFc (DAZ gene). Offspring if male
will also be infertile.
– CBAVD : check for cystic fibrosis gene in patient
plus partner
ICSI
 Oocyte collection. Stimulate superovulation with human
menopausal gonadotrophin (hMG) or pure recombinant FSH,
then hCG

 Ovaries enlarge to tennis ball size. Oocytes removed by needle

aspiration through posterior fornix with TVUSS guidance

 Remove cumulus cells. Inject a paralysed sperm into the

cytoplasm.

 Fertilization rate is 60-70% with < 10 % ova damaged during

ICSI
 IVF / ICSI
ICSI
Partial
Zona
Diossection
PZD

Standard IVF

Subzonal
Injection
SUZI
Results
 Sperm can be retrieved in 100% of men with obstructive
azoospermia and 50% of men with non obstructive azoospermia.
Even in sertoli-cell only etc : pockets with PESA/MESA and MESE

 In year 2000 in the UK

– 12051 cycles of IVF : 2861 live births = 23.7 % THBR
– 9322 cycles of ICSI : 2246 live births = 24.1% THBR
– < 10% oocytes were damaged during ICSI

 30-40% multiple pregnancy rate (2-3 zygotes used <35 yrs female)

 In 1998 in the UK
– 7937 babies born with IVF / ICSI : congenital abnormality rate almost
identical to general population 1.1 % / 1.6%
ICSI MCQ
 Has a significant risk of multiple pregnancy because more than
one sperm can be accidentally injected
 Has superceded partial zona dissection (PZD) and subzonal
injection (SUZI)
 Is regulated by the Human Fertilization and Embryology
Authority (HFEA) after passing of the Human Fertilization and
Embryology Act in 1990
 Is indicated only in male factor infertility
 Has had a negative impact on the thorough treatment of
obstructive azoospermia by Urologists