ICSI in Malaysia

ICSI is to help those with fertilization failures when few sperm cells are available.

Intracytoplasmic sperm injection (ICSI) is a medical advancement in the individuals and couples seeking fertility. Several methods known as assisted reproductive technologies are used such as Vitro Fertilization (IVF). The goal of assisted reproduction in the case of ICSI is to help those with fertilization failures when few sperm cells are available. The process is performed when individual sperm is injected into a mature oocyte cytoplasm. It is given during a single IVF cycle and aids in assisting fertilization for couples in which the male’s semen is underproduced or not optimal for successful reproduction. First performed in the late 80’s, this procedure has demonstrated higher fertilization, rendering it successful for male factor infertility treatment. The rate of successful fertility post ICSI is ranging from 80% fertility to 45% pregnancy. This article focuses on the evaluation, procedure and results of Intracytoplasmic sperm injection today.

The primary step in ICSI is properly evaluating the patient’s semen. Seemen anaylsis looks for morpholical changes, concentration, motility, antibodies and several other factors. Those who have male factor infertility and failed previous fertilization attempts or pre implantation techniques are deemed proper candidates. Though most commonly used for male factor infertility, it is also used for specific female infertility in those who have dysmorphic or oocyte anomalies. Those afflicted with HIV or viral hepatic diseases may seek ICSI as a better alternative. This pre implantation technique and genetic diagnoses can be used to ensure absence of virally contaminated DNA from other sperm. The next step after successful analysis is sperm retrieval. Sperm is obtained from post ejaculatory semen. Another alternative is surgical retrieval from the testicles from those suffering from ejaculatory dysfunction or cancer. Microsurgical epididymal sperm aspiration (MESA), testicular sperm from biopsy (testicular sperm extraction [TESE]) or fine-needle aspiration are surgical alternatives, which have been deemed successful. Rates are higher for those afflicted with chromosomal disorders such as Klinefelter syndrome or those with nonobstructive low sperm count (azoospermia).

Once sperm is retrieved, selecting which are most viable must be assessed. By injecting sperm directly, the process of natural selection is bypassed, so it is pivotal to asses the best fit sperm for injection into an oocyte. The more morphologically normal and optimal the sperm is, the higher the rate of fertilization and implantation. Motility is secondarily assessed as impaired motility is most related to impaired fertilization. Sperm is retrieved and treated with liquids to stimulate motility. Those most viable and continue in motility after processing are used to be selected as viable sperm for injection. Assessing DNA and those with undamaged DNA is another criteria in evaluating viable sperm. Hyaluronic acid binding is another effective method in determining optimal sperm. Those that bind to the acid are able to compete naturally to attach to the zona pellucida of oocytes effectively. The selection of mature sperm bound to hyaluronic acid aid in selecting sperm with low levels of chromosomal and anatomical abnormalities.

The physical technique of Intracytoplasmic sperm injection requires a skilled embryologist and Reproductive endocrinology and infertility physician, balanced temperature and PH environments. Sperm is assessed and visualized by a powerful microscope with heated optics to maintain natural temperatures as in fertility. The microscope is used to monitor injection position and manipulate movements precisely the oocyte of a female is obtained during IVF procedures. The oocyte is treated with hyaluronidase to strip cumulus cells for ease of injection. A pipette contained the sperm is then gently injected through the zona pellucida to the center most portion of the oocyte. The cytoplasm is broken and aspirated for activation on fertilization. The fertilization is then implemented and followed by a 50-80% success rate. The failure for fertilization is usually due to inactivation or sperm nonviability. Injection also poses a <10% risk of oocyte damage adding to infertility post treatment. Post ICSI, assessment of the pronucleus is essential to determine fertilization and any oocytes abnormal post fertilization must not be used. Embryo quality post ICSI is the last step in determining success. Making sure no damage occurs to the embryo after injection is evaluated for proper implantation. In the end, over 30% of ICSI treatments result in birth. There also are studies that reveal ICSI may increase the chances of twins with placentation. Regardless, all studies show children conceived via ICSI vs naturally share similar rates for growth and development. This is reassuring for those seeking fertility and worried about genetic or physical risks. In the end, Intracytoplasmic sperm injection (ICSI) is indicated primarily for treatment of male factor infertility and for treatment of couples with past failed fertilization treatments.

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