IVF with ICSI: A Solution for Male Infertility

ICSI: An Overview of This Assisted Reproductive Technology (ART)

In vitro fertilization (IVF) is an assisted reproductive technology (ART) that involves fertilizing an egg in a laboratory and then transferring the embryo into the uterus (in vitro fertilization and embryo transfer). It's arguably the best-known technique, having enabled the birth of the first test-tube baby in 1978 (Louise Brown). Treatment usually involves ovarian stimulation to obtain multiple eggs for fertilization, rather than a single egg. Once egg maturation is confirmed through ultrasound monitoring and hormone assays, transvaginal oocyte retrieval is performed. On the same day, a semen sample is collected from the male partner. The gametes are then combined in a test tube (in vitro), where fertilization – the union of egg and sperm to form an embryo – occurs naturally, without manipulation. After 2 to 5 days (or more), one or more incubated and monitored embryos are implanted into the woman's uterus.

ICSI (Intracytoplasmic Sperm Injection) is a more recent ART technique, developed since the 1990s. It's indicated for cases of severe male infertility due to low sperm count or reduced motility. Gamete retrieval is the same as for IVF, but fertilization is mechanical: a single sperm is injected directly into the egg using ICSI. Embryo culture and transfer remain the same.

IVF with ICSI: What does it involve?

ICSI is preferred when the male partner's semen sample is compromised, reducing the chances of natural fertilization in vitro (as in IVF).

Embryologists select the best sperm based on shape and motility and inject them individually into each oocyte using a micromanipulator. The embryologist's expertise is crucial for handling the gametes and increasing the chances of viable embryos. IVF and ICSI can be used together, depending on the embryologist's assessment.

ICSI: What is the difference with IVF?

The main difference between IVF and ICSI is how fertilization occurs: naturally in IVF, and by intracytoplasmic injection in ICSI. While collection, culture, and transfer procedures are similar, the methods are not identical and are indicated for different patients based on their specific fertility issues. A complete diagnostic investigation is crucial to determine the best treatment for each couple. Consulting a qualified fertility center is recommended.

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ICSI, a victory over male infertility

ICSI is an ART technique often associated with male infertility.

ICSI is indicated for:

• Men with low sperm count, motility problems, or abnormal sperm morphology.
• Repeated IVF and artificial insemination failures, insufficient oocytes after retrieval, or previous natural fertilization failures.
• Men who have undergone a vasectomy.
• Cases with limited sperm samples, allowing optimal use:
• Men undergoing radiotherapy or chemotherapy.
• Patients with ejaculation difficulties, such as retrograde ejaculation.
• Men with no sperm in their ejaculate (sperm can be obtained via testicular biopsy).

Is ICSI a risk-free ART technique?

To avoid complications, ovulation induction protocols must be carefully monitored to prevent ovarian hyperstimulation syndrome (OHSS), which involves excessive follicle maturation and egg production. OHSS can cause symptoms like shortness of breath, nausea, and painful ovarian enlargement. Severe cases may involve abdominal distension and blood clots, requiring hospitalization. Laparoscopic procedures for egg retrieval can also lead to peritoneal infection. There's also an increased risk of multiple pregnancies due to the potential transfer of multiple embryos.

IMSI: ICSI times 10

IMSI (intracytoplasmic morphologically selected sperm injection) involves injecting morphologically selected sperm. Unlike ICSI, sperm selection is performed at 8000x magnification, identifying morphological alterations (e.g., vacuoles) affecting embryo implantation, quality, miscarriage, and birth rates. This technique is suitable for couples with repeated embryo transfer failures due to fertilization or embryo maturation issues, severe teratozoospermia (abnormal sperm morphology), or high sperm DNA fragmentation.

Currently, definitive conclusions on IMSI's effectiveness compared to classic ICSI are lacking. Literature on prospective randomized studies doesn't justify its routine clinical use.

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