Intracytoplasmic sperm injection (ICSI) is a form of IVF treatment that involves injecting a single sperm into each egg using very fine micromanipulation equipment.
As the human egg is one-tenth of a millimeter in diameter and the sperm is 100 times smaller, this is a very delicate procedure performed by highly skilled embryologists using a sophisticated microscope. Dr Daniel Lantsberg has offered ICSI treatment in East Melbourne for several years.
Who May Require ICSI?
For many couples where sperm quality is poor, conventional IVF is unlikely to result in fertilization. In such cases, your fertility specialist will recommend IVF with ICSI. ICSI is also used where sperm has been obtained directly from the testis, for example, after vasectomy reversal or in cases of absent vas deferens.
ICSI has not been shown to increase fertilization rates in situations where the sperm assessment is normal. Normal fertilization rates with IVF or ICSI are approximately 50-60%. That is, for every 10 mature eggs obtained and combined with the sperm either with IVF or ICSI, approximately five to six will fertilize normally on average.
If there is evidence of poor outcomes with previous IVF treatment, your Melbourne IVF fertility specialist may recommend you undergo ICSI & Intracytoplasmic morphologically selected sperm injection (IMSI)to improve your chances of fertilization.
Are There Potential Risks With ICSI?
Most pregnancies conceived by ICSI proceed without complications. However, compared to spontaneous conceptions, both IVF and ICSI carry a small increase in the risk of still birth, premature birth, low birth weight and multiple birth. The risk of miscarriage after ICSI is around 20% which is the same as after IVF.
One child in 14 conceived by ICSI have a birth defect. This is similar to the rate seen after IVF, but higher than in the general population, where birth defects occur in one in 25 children.
The vast majority of babies born as a result of ICSI are healthy and have no short or long-term problems. When health effects are found, it is difficult to determine whether these are due to the underlying health problems that contribute to infertility, the egg and/or sperm retrieval processes, or the ICSI procedure
Essential Steps Before Starting ICSI Treatment
As you consider ICSI as a treatment option for your fertility issues, there are some important steps that should be taken in order to ensure a successful and safe procedure. These include:
Comprehensive Health Check-up
Prioritise a thorough health check-up for both partners. This includes screenings for any existing medical conditions, infections, or chronic illnesses that might impact fertility.
AMH
Anti-Müllerian Hormone (AMH) is a protein hormone produced by the cells within a woman’s ovarian follicles. Its levels in the blood provide valuable insight into a woman’s ovarian reserve, or the quantity of her remaining egg supply. Assessing AMH levels is crucial prior to undergoing In Vitro Fertilization (IVF) because it helps fertility specialists gauge the ovarian response to fertility drugs. High AMH levels typically indicate a good ovarian reserve, suggesting a potentially better response to IVF medications and a greater number of eggs available for retrieval. Conversely, low AMH levels may signal a reduced ovarian reserve, guiding fertility specialists to tailor treatment strategies more appropriately. Thus, AMH assessment plays a pivotal role in the planning and optimization of IVF treatment, aiming to enhance the chances of success and provide personalized care for each individual.
Semen Analysis
Conduct a semen analysis to evaluate the quality and quantity of sperm in the male partner. This is important as ICSI relies on a single sperm being injected into an egg, so it is crucial to ensure there are enough healthy sperm available.
Pelvic Ultrasound
Schedule a pelvic ultrasound for the female partner to examine the uterus, fallopian tubes, ovaries, and surrounding structures. This helps identify any structural abnormalities that might affect fertility.
STI Screening
Both partners should undergo screening for sexually transmitted infections (STIs). Infections such as chlamydia or gonorrhea can impact fertility and may require treatment before proceeding with ICSI.
Body Mass Index (BMI)
Maintain a healthy BMI, as both underweight and overweight conditions can affect fertility. Strive for a balance that supports overall well-being and reproductive health.
Blood Pressure Check
Monitor blood pressure levels to ensure they are within a healthy range. Elevated blood pressure can have implications for reproductive health, and managing it is crucial during fertility treatments.
Diabetes Screening
Check for diabetes, as uncontrolled diabetes can affect fertility. Effective management and monitoring of blood sugar levels are crucial factors to address before starting ICSI treatment.
Thyroid Function Tests
Assess thyroid function through tests for thyroid-stimulating hormone (TSH), free T3, and free T4. Thyroid imbalances can impact fertility, and correcting any abnormalities is important.
Medical History Review
Share detailed medical histories with the fertility specialist, including any previous surgeries, treatments, or health issues. This comprehensive information helps in tailoring the ICSI treatment plan to individual needs.
Key Elements Impacting ICSI Success
During Intra-Cytoplasmic Sperm Injection (ICSI) treatment, success depends on various factors. Knowing these key elements can offer valuable guidance for individuals and couples going through assisted reproduction. Such are:
Oocyte Quality: The quality of the eggs is paramount. High-quality oocytes have a better potential for fertilization and development into healthy embryos.
Sperm Quality: While ICSI can overcome many issues related to sperm quality, the success of the procedure can still be influenced by the health and viability of the sperm used for injection.
Embryologist’s Skill: The expertise and experience of the embryologist performing ICSI are critical factors in the success of the procedure. Precise technique and handling are necessary to minimize damage to the egg and ensure successful fertilization.
Uterine Environment: A receptive uterine environment is crucial for the implantation and growth of the embryo. Factors such as the thickness of the endometrial lining and the presence of uterine abnormalities can affect success rates.
Patient Factors: Age, particularly of the female partner, significantly impacts ICSI success rates, with younger women generally having higher success rates. Additionally, underlying health conditions and fertility issues can influence outcomes.
Laboratory Conditions: The conditions under which ICSI is performed, including the quality of the laboratory environment and the culture media used, play a significant role in the success of the procedure.
By addressing and optimizing: these key elements, fertility specialists can improve the chances of a successful pregnancy through ICSI.
Embryo Development: Following fertilization, the development of embryos is a critical phase. Monitoring the growth and quality of embryos is essential for selecting the most viable ones for implantation. Factors such as the number of cells, symmetry, and overall appearance influence the probability of success through ICSI treatment.
Individual Response to Medications:The response of individuals to fertility medications used during ICSI treatment can vary. Monitoring and adjusting the medication protocol based on an individual’s response help optimize the chances of successful egg retrieval and fertilization.
Understanding these key elements provides individuals and couples with valuable information as they navigate the complexities of ICSI treatment. Dr Lantsberg and his team work closely with patients, considering these factors to tailor treatment plans that maximize the chances of a successful outcome.
Are There Potential Risks With ICSI?
Children born through Intracytoplasmic Sperm Injection (ICSI) exhibit a slightly higher rate of birth defects compared to those conceived naturally, with studies suggesting an increase in risk by approximately 1-2 percentage points above the baseline risk of 3-4% in the general population. This minor increase is influenced not only by the ICSI procedure itself but also by underlying genetic or health conditions in parents opting for fertility treatments. The slightly elevated risk underscores the importance of comprehensive counseling and personalized care from fertility specialists, who can navigate couples through the complexities of fertility treatments, taking into account the specific risks and benefits relevant to their situation.
The vast majority of babies born as a result of ICSI are healthy and have no short or long-term problems. When health effects are found, it is difficult to determine whether these are due to the underlying health problems that contribute to infertilityor the ICSI procedure.
If you are in Melbourne and looking for an ICSI treatment clinic, we are happy to serve you. To learn more about ICSI and associated costs, please visit https://www.mivf.com.au/treatments-services/ivf-procedures/icsi-treatment.
Frequently Asked Questions
Who may require ICSI?
ICSI is typically recommended for couples where:
- Abnormal sperm parameters (e.g., low count, poor motility, abnormal shape)
- Sperm has been surgically retrieved (such as after vasectomy reversal or in cases of absent vas deferens)
- Previous IVF cycles have shown poor fertilization outcomes
ICSI is not routinely recommended if sperm parameters are normal, as it does not increase pregnancy rates in such cases. - Genetic testing of embryos for a specific mutation (PGT-M) or chromosomal rearrangement (PGT-SR)
What are the steps before starting ICSI treatment?
Before starting ICSI, both partners should undergo:
- Comprehensive health check-ups
- AMH (Anti-Müllerian Hormone) assessment for ovarian reserve
- Semen analysis
- Pelvic ultrasound for the egg provider
- STI screening
- Blood pressure check
- Diabetes screening
- Thyroid function tests
- Detailed medical history review
What factors impact ICSI success?
Success depends on several key elements:
- Embryologist’s skill and experience
- Quality of the Lab and equipment used
- Oocyte (egg) quality
- Sperm quality
- Uterine environment (including endometrial thickness and absence of abnormalities)
- Patient factors (especially the age of the female partner/egg provider)
- Individual response to fertility medications
- Embryo development post-fertilization
What are the potential risks with ICSI?
- The risk of miscarriage after ICSI is similar to standard IVF and is mostly related to the age of the egg being used
- There is a slightly higher risk of birth defects in children conceived by ICSI ~1.2–1.4x increased relative risk compared to natural conception or conventional IVF. This translates to an absolute risk increase of about 1–2 additional cases per 100 births and underlying infertility is likely a major contributor
- There is a no increase in the risk of stillbirth, premature birth, low birth weight with ICSI compared to IVF
Are most ICSI pregnancies successful?
The majority of pregnancies and babies resulting from ICSI are healthy, with no short- or long-term problems. When health issues do occur, it can be difficult to determine if they are due to the ICSI procedure itself or the underlying infertility issues
What is the difference between ICSI and IVF?
ICSI (Intracytoplasmic Sperm Injection) is a specialized form of IVF where a single sperm is injected directly into an egg using micromanipulation tools. IVF allows sperm to fertilize the egg naturally in a petri dish. ICSI is typically recommended when sperm quality is poor or if previous IVF cycles failed to fertilize eggs.
Does ICSI increase the chances of fertilization for all patients?
No, ICSI is most beneficial in cases of male infertility or previous fertilization failures. For patients with normal sperm parameters, studies show ICSI does not significantly improve fertilization or pregnancy rates compared to conventional IVF.
Can ICSI be used with frozen eggs or sperm?
Yes, ICSI is commonly used with frozen sperm or eggs, especially in cases of donor sperm use or fertility preservation (e.g., cancer patients). The technique helps improve fertilization rates when thawed reproductive cells are used.
Is genetic testing recommended after ICSI?
Genetic testing is not automatically required after ICSI, but it may be recommended in certain situations — especially when there is a history of miscarriages, or known genetic risks.
Is ICSI recommended for older women?
ICSI isn’t recommended based on age alone — it’s mainly used when there are sperm-related issues or a history of poor fertilisation.
At Dr Daniel Lantsberg’s clinic, we don’t use ICSI by default. Instead, we carefully assess the sperm, egg quality, and previous cycle outcomes to decide if ICSI offers a clear benefit for your situation.