ICSI Treatment: Procedure, Risks, and Success Rates

Intracytoplasmic sperm injection (ICSI) is a treatment for infertility with an increased chance of a successful pregnancy. Here is some information about infertility treatment and who is best suited to it and what the process looks like. In this article, we’re going to describe everything you should know about ICSI such as the ICSI process, success rate, and how ICSI treatment works.

ICSI (Intracytoplasmic Sperm Injection)

ICSI—or intracytoplasmic sperm injection—is a more advanced technique under the umbrella of assisted reproductive technology, developed to manage problems that cannot be solved by in vitro fertilization, such as a male partner who has undergone a vasectomy or whose sperm is unhealthy or a female partner with uterus problems or who has had surgery on the uterus, whose fallopian tubes are narrowed or blocked, or who is experiencing Polycystic Ovarian Syndrome (PCOS).

With ICSI the scientist will select the healthiest egg and the healthiest sperm and inject the sperm directly into the egg to fertilize it into an embryo. Once it has grown enough the embryo is placed back into the uterus where it may continue to grow in pregnancy. ICSI is more successful than other methods and is an option for families that have tried other assisted reproductive technologies without success.

The difference between ICSI and IVF

With ICSI, the one strongest sperm will be injected directly into the highest quality egg. Once the egg is fertilized, becoming an embryo, it will continue to develop in the laboratory. This embryo will continue to grow in a special solution until it becomes a blastocyst, where it will then be transferred back to the uterus to continuing growing in pregnancy.

IVF involves selecting an egg and sperm and combining them in a laboratory to hopefully create an embryo. The embryo is then transferred into the uterus to hopefully progress into a successful pregnancy.

The difference between ICSI and IVF is the deliberate fertilization where the sperm is injected directly into the egg rather than allowing them to combine on their own. Therefore ICSI is often more successful, where the healthiest egg and sperm are used only.

Who should consider ICSI?

• Couples who have been trying to become pregnant for a long time and have not been successful.
• Someone experiencing infertility.
• Men with low-quality sperm, whether the problem is with shape, motility, or number.
• Men who have had vasectomies, but are still producing sperm that can be extracted using PESA, TESE, etc.
• Women with blocked or narrowed fallopian tubes.
• Women experiencing abnormal ovulation.
• People with genetic conditions.
• Couples who have had no success with IVF.
• Couples who would like their embryos tested for chromosomal abnormalities (NGS).

 

The ICSI Procedure (Step-by-step)

The ICSI procedure is made up of six steps as follows:

1. Doctor consultation
The doctor will explain the procedure and preparation and set up the treatment plan. (Please see the doctor before your period.)

2. Ovarian stimulation
The female partner will undergo a health assessment to ensure she is ready for ICSI. She will then undergo ovarian stimulation to help several eggs grow at the same time. She will receive an ovarian stimulation injection on the 2nd or 3rd day of her cycle, with injections daily for 8-10 days to produce more eggs than during normal ovulation. The goal is to collect 8-15 eggs.

3. Egg and sperm collection
Once the eggs have reached the desired sizes, the doctor will remove them from the ovaries within 24-36 hours. The procedure is done under sedation and a needle is inserted through the vagina into the ovaries to collect the eggs, with ultrasound to guide the doctor. Fasting is required for the procedure so the female partner shouldn’t eat or drink for at least 6 hours. The eggs will be cleaned in a specific solution and stored in the laboratory to be fertilized by sperm.

Sperm also needs to be collected. The male partner will ejaculate into a prepared container and the sample is taken to the laboratory so that the healthiest sperm can be selected for fertilization. An ICSI machine and a camera is used to inject the healthiest sperm into the healthiest egg in the laboratory. If the male partner is unable to ejaculate, sperm is collected from the testicles directly.

4. Embryo development (Blastocyst culture)
Embryos are kept in the sterile laboratory for 3-5 days where the environment is ideal for helping them develop, with the appropriate temperature, light, humidity, and pressure. The embryo is placed in a special solution appropriate for its development, in a storage container with the right temperature, humidity, pH balance, and gas. This process is as close to the natural process in the human body as possible. Embryos are stored until they become blastocysts (day 5), which is when they are strong enough to be transferred back into the uterus so they can implant and develop in pregnancy.

5. Embryo transfer
Once ready, the doctor and patients will select an embryo to be transferred into the uterus. This is done by inserting a small plastic tube through the vagina into the uterus, with ultrasound helping guide the perfect placement of the embryo.

6. Pregnancy test
The doctor will schedule blood tests every three days after embryo transfer to check hormone levels. Pregnancy can be tested for 14 days after the transfer.

Preparation before ICSI Treatment

Female Preparation

• Avoid alcohol, processed foods, and foods high in added sugar.
• Eat at least 60 mg of protein each day to improve egg quality.
• Drink at least 1.5-2 liters of water each day.
• Maintain a healthy body weight and exercise moderately by walking or doing yoga.
• Avoid smoking and being exposed to secondhand smoke.
• Get adequate rest each day and manage stress.

 

Male Preparation

• Avoid soaking in hot water and using the sauna.
• Avoid tight underwear.
• Avoid caffeine and alcohol.
• Avoid cigarettes for at least three months before the procedure and through until after the treatment.
• Exercise regularly, get plenty of rest, and manage stress.

 

Pros and Cons of ICSI for Infertility

Pros of ICSI

• It is currently the ART with the highest success rate.
• It can treat a variety of problems.
• No surgery is required.
• It can be done even after a tubal ligation.
• It can be done even with low sperm motility.
• Genetic testing (next-generation sequencing or NGS) of the embryo can be done before it is transferred.

 

Cons of ICSI

• ICSI costs significantly more than IUI.
• It has a more complicated procedure.
• The procedure lasts many days.
• Some patients may experience side effects from egg collection, such as abdominal discomfort.

 

ICSI Success Rates

The success of ICSI depends on a number of factors, such as age, cause of infertility, previous pregnancies, etc. It is important to discuss the rate of success of ICSI with your doctor for the most accurate information.

The success of ICSI depends on:

• The age of the female partner; the older the female partner, the fewer her eggs.
• The number of eggs collected.
• The quality of eggs collected.
• The health of the sperm.
• The thickness of the uterine lining on the day of transfer.

 

ICSI fertilization failure reasons

These are the main causes of ICSI failure:

• The most common reason for failed ICSI has to do with the embryo itself. Even if the embryo is stored and developed in the laboratory with the most appropriate temperature and cared for by embryologists, fertilization can produce both low-quality and high-quality embryos. Low-quality embryos, whether they developed too slowly or incompletely in the laboratory, don’t often implant in the uterus once transferred.
• Another reason for failed ICSI is due to the uterus. The health of the uterus is an important factor when it comes to a successful pregnancy. No matter how high-quality the embryo is, if the uterus is not healthy, the embryo cannot implant. Furthermore, if any polyps or growths are found in the uterus, this will make it even harder for the embryo to implant.
• Autoimmune problems in the female partner can impact cell walls and blood circulation, and these can impact blood flow to the uterus and prevent an embryo from implanting, leading to miscarriage.
• Problems with the endocrine system, such as thyroid disease that can lead to elevated prolactin levels, can cause difficulty in getting pregnant. These problems can be managed by the doctor before the ICSI process if you let the doctor know or if it is found through blood tests before fertility treatment is started.

 

ICSI Treatment Cost

When compared with intrauterine insemination (IUI), ICSI costs significantly more, but it is a worthwhile investment when dealing with infertility. The starting cost of ICSI is 200,000 baht and can go up to 500,000 baht per cycle, depending on the facility. ICSI is an involved process that is made up of several important steps: ovarian stimulation, preventing ovulation, triggering egg maturation, ultrasounds, egg and sperm collection costs, and the ICSI procedure itself—all of these have their own expenses.

At Beyond IVF we are please to offer a promotion price of 229,000 baht for one cycle of ICSI, which covers almost the entirety of the ICSI process.

FAQs about ICSI

How long does the ICSI process take?
The ICSI process begins on the second day of your period when you will be asked to come in for bloodwork and an ultrasound. Ovarian stimulation begins then and injections are administered daily for 10-12 days. During this time the doctor will ask you to come in occasionally. Two days after the last injection the doctor will schedule egg and sperm collection. The egg will be fertilized using the ICSI procedure and embryos will be grown and tested before being transferred to the uterus, a process that takes approximately 15 days. So one cycle of ICSI takes about a month.

Is the ICSI procedure painful?
Some aspects of the ICSI procedure can be uncomfortable, such as the blood tests and injections. Sedation and anesthesia is used for the egg collection procedure so there should be no pain with that. Possible side effects include lower abdomen pain, slight vaginal bleeding, and abdominal discomfort. If you experience any adverse effects from the procedures or medications, please let your doctor know immediately.

Can ICSI decide gender?
In Thailand it is against the law to choose gender of the embryo, but next-generation sequencing (NGS) of the embryo to check chromosomes also reveals the embryo’s gender (XX for female and XY for male). It is recommended that the healthiest embryo be transferred rather than focusing on the gender of the embryo.

Can ICSI cause twins?
In Thailand intentionally implanting multiple embryos in hopes of a twin pregnancy is not allowed and medically speaking, a twin pregnancy is considered higher risk. It is not recommended that you carry more than one baby at a time. However, in some cases the doctor may recommend transferring two embryos if they are of lower quality, with the hope that one will implant. In some cases, both embryos may implant, resulting in a twin pregnancy.

How successful is ICSI after vasectomy?
ICSI is not just a treatment option for infertility but can also help families become pregnant after a vasectomy or tubal ligation. ICSI bypasses any procedures done to prevent pregnancy as well as any narrowed or blocked fallopian tubes as sperm and egg can be collected directly from the testicles and ovaries. The ICSI procedure is as follows:

• Ovarian stimulation
• Egg/sperm collection
• Egg fertilization in the laboratory
• Embryo development
• Embryo transfer through the vagina (no surgery required)

 

Final Thoughts

ICSI is a special procedure built on the IVF process to increase the chances of pregnancy. If you are experiencing fertility problems or think you may be infertile, please meet with a doctor first. Your doctor will carry out a thorough evaluation and offer you appropriate treatment options that are best suited for you and your family. If you are searching for an IVF center in Bangkok, please contact us Beyond IVF.

Thank you to BeyondIVF, IVF center in Bangkok for sharing knowledge.