Infertility can be an emotional and challenging journey for many couples. However, modern advancements in reproductive medicine, such as Intracytoplasmic Sperm Injection (ICSI), offer a promising solution. Designed to address even the most complex cases of infertility, ICSI has brought the dream of parenthood within reach for countless individuals. Whether the issue lies in low sperm count, immotile sperm, or other male infertility factors, this groundbreaking technique provides new hope for building a family.
The most common method is to use fresh ejaculate; however, this is not always possible for all male partners contributing sperm for intracytoplasmic sperm injection (ICSI). In some cases, surgical removal of sperm from the testes may be required. It is also possible to collect sperm from the urine if the man experiences retrograde ejaculation, where sperm travel backward into the bladder instead of forward into the penis. Men who cannot ejaculate due to nerve injury may be able to produce sperm through electro-ejaculation.
Couples undergoing the ICSI-ET cycle, or intracytoplasmic sperm injection, experience a procedure very similar to in vitro fertilization (IVF). The woman first receives a course of hormone treatment to stimulate her ovaries to produce multiple eggs. These eggs are monitored via ultrasound, and once mature follicles have formed, the eggs are collected using a thin tube inserted through the vagina. The collected eggs are placed in a special culture fluid in the laboratory.
On the same day, sperm is collected, typically just before the egg retrieval. A single sperm is then injected into each egg. This process is repeated for all available eggs, which are cultured to determine whether they develop into embryos. The best-quality embryo at the 2–3-day stage or the strongest blastocyst at the 5–6-day stage is then transferred to the woman’s uterus. Different countries have specific regulations regarding the number of embryos that can be transferred. For example, in the UK, the limit is typically 1–2 embryos, while other countries may allow more, increasing the risk of multiple pregnancies.
The success rates for ICSI are similar to those of IVF and depend on factors such as age and the stage at which embryos are transferred. Blastocyst transfer at the 5–6-day stage generally has higher success rates than embryo transfer at the 2–3-day stage.
Potential problems with intracytoplasmic sperm injection
Most children born as a result of ICSI are healthy. However, there is a risk that if the father produces abnormal sperm, the issue may be genetic and could be passed on to the child. Known genetic diseases may be tested using pre-implantation genetic screening (PGS), but no test exists for unidentified abnormalities.
ICSI also carries the same risks as standard IVF, including an increased likelihood of multiple pregnancies, a higher risk of ovarian hyperstimulation in the female partner, and a greater chance of ectopic pregnancy due to implantation in the fallopian tubes.
The development of ICSI in Iran has been significantly influenced by collaborations between its pioneers and interdisciplinary experts, supported by the endorsement of Shia jurists.
Embryo transfer is a straightforward procedure following ICSI and IVF, often considered the simplest and final step in the in vitro fertilization process. The goal of embryo transfer is to facilitate conception after successful fertilization.
Embryos are generally transferred to the woman’s uterus during the 2–8 cell stage. This typically occurs between days 2–4 after egg retrieval but may vary from day 1 to day 6. Some clinics allow embryos to develop to the blastocyst stage, which occurs around day 5, before transfer.
This cycle includes both in vitro maturation (IVM) and embryo transfer (ET), ensuring the best chances for conception through advanced reproductive techniques.
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