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Has a significant risk of multiple pregnancy because more than one sperm can be accidentally injected Has superceded partial zona dissection (PZD) and subzonal injection (SUZI) Is regulated by the Human Fertilization and Embryology Authority (HFEA) after passing of the Human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