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"ICSI
can be effective when as few as one sperm can be obtained and was a major breakthrough in the treatment of male infertility."
ICSI
ICSI revolutionized
the treatment of infertility . In the past many
considered infertility to be a "female problem"
but we now know that male factor infertility is present
in up to 47% of infertile couples. No treatment of the
female should begin until her partner has had a thorough
evaluation including a semen analysis.
Before ICSI, the only option for couples
with male factor infertility was intrauterine insemination (IUI) . Without ICSI, in cases of moderate
to severe male factor, it was often necessary to use
a sperm donor.
ICSI is used in conjunction with
IVF and pregnancy can be achieved with as few as one
sperm. Unfortunately, there are few effective treatments
to increase sperm quantity and quality unless there
is a specific, responsive cause such as a blockage or
severe hormone imbalance. Most of the medical therapies
promoted through Internet sites have not demonstrated
effectiveness.
ICSI with IVF can be used to treat a varicocele in the male. A varicocele
is a blockage of the veins in the scrotum which interferes
with temperature regulation. Sperm require a relatively
narrow range of temperatures to develop properly. Read
the section on male
infertility for more information. Surgery is also often effective in treating a varicocele.
ICSI was first offered by
our California fertility clinic in the 1990's. Our fertility specialists and embryologists have extensive experience with intracytoplasmic sperm injection and achieve high fertilization rates. The procedure allows men with little, or sometimes no, sperm in their
ejaculate to create genetically related children.
 ICSI-
The Process
After egg retrieval, they are separated from the
follicular fluid, placed in a Petri dish, and examined
under a microscope.
A small hole
is made in the zona pellucida (egg membrane) using microscopic
tools and the sperm is inserted directly into the egg. After insertion of the sperm (ICSI), the embryos
are placed in incubators until ready for transfer.
ICSI requires that
sperm be obtained from the ejaculate if the male has
sufficient quantity and quality of sperm. When adequate
sperm are not available,
PESA or TESA can be utilized. Our California clinics
offer ICSI, PESA, TESA,
and many other advanced micromanipulation procedures.
ICSI combined with
PESA (percutaneous epididymal sperm aspiration) is a
noninvasive method of sperm recovery and has excellent
potential for patients who have had a vasectomy and
do not wish to undergo surgical reversal, or patients
who have had a reversal that failed. The success rates per cycle exceed those for a vasectomy reversal.
ICSI combined with PESA requires that a small needle
be placed into the epididymis, using local anesthesia,
to withdraw the sperm. The epididymis normally serves
as a reservoir for sperm. This technique would also
be applicable for patients with congenital absence of
the vas deferens, previous infection with resultant
occlusion of the epididymis, and ejaculatory dysfunction
due to multiple sclerosis or diabetes.
ICSI/
TESE (testicular sperm aspiration) is useful for
men who have non-obstructive azoospermia caused from
maturation arrest disorders and for patients in whom
sperm could not be obtained through the PESA procedure.
Using TESA, sperm are obtained by biopsy of the testicle.
ICSI combined with PESA/TESA is relatively
simple, the equipment required is minimal and the procedures
are much less invasive than the previous microsurgical
approaches. The patient is able to return to work either
the same or the following day without significant risk
of complications. The sperm recovery rate is approximately 92% and the average pregnancy rate
is 45%. Review our intracytoplasmic sperm injection
- IVF success rates Web page.
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