San Diego ICSI Insemination
Intracytoplasmic Sperm Injections
Intracytoplasmic Sperm Injection (ICSI) is a delicate laboratory procedure
that uses a micro-manipulator and high-resolution magnification systems
to identify the healthiest sperm, isolate that sperm, and inject it directly
into the egg that we have retrieved.
The negative effects of abnormal semen characteristics and sperm quality
on fertilization can be overcome with ICSI if viable sperm are available
because the technique bypasses the shell around the egg (zona pellucida)
and the egg membrane (oolemma) to deliver the sperm directly into the
egg. ICSI involves the direct injection of a single sperm into the interior
of an egg using an extremely thin glass needle. ICSI allows couples with
male factor infertility to achieve fertilization and live birth rates
close to those achieved with in-vitro fertilization (IVF) using conventional
methods of fertilization in men with normal sperm counts. ICSI can be
performed even in men with no sperm in the ejaculate if sperm can be successfully
collected from the epididymis or the testis.
Research on ICSI Birth Defects & Success Rates
Reports on the risk of birth defects associated with ICSI (compared to
those associated with conventional fertilization in IVF cycles) have yielded
conflicting results. Even if there is an increased risk of congenital
malformations in children conceived with ICSI, the risk is relatively
low (4.2% versus ~3% of those conceived naturally).
The impact of ICSI on the intellectual and motor development of children
conceived via ICSI also has been controversial. An early report suggested
that development in such children lagged significantly behind that of
children resulting from conventional IVF or those conceived naturally.
However, more recent studies from larger groups, using standardized criteria
for evaluation, have not detected any differences in the development or
the abilities of children born after ICSI, conventional IVF, or natural
Male Infertility & Genetic Disorders
Some men are infertile because the tubes connecting the testes to the penis
did not form correctly. This condition, called congenital bilateral absence
of the vas deferens (CBAVD), can be bypassed by aspirating sperm directly
from the testicles or epididymis, and using them in IVF with ICSI to achieve
fertilization. However, men with CBAVD are affected with a mild form of
cystic fibrosis (CF), and this gene will be passed on to their offspring.
All men with CVABD, as well as their partners, should be tested for CF
gene mutations prior to treatment, so that the risk of their offspring
having CF can be estimated and appropriate testing performed. It is important
to understand that there may be CF gene mutations that are not detectable
by current testing and parents who test negative for CF mutations can
still have children affected with CF.
Some men have no sperm in their ejaculate because their testes do not produce
adequate quantities (non-obstructive azoospermia). This can be due to
a number of reasons such as prior radiation, chemotherapy or undescended
testicles. In some men, small deletions on their Y chromosome lead to
extremely low or absent sperm counts. Testicular biopsy and successful
retrieval of viable sperm can be used to fertilize eggs with ICSI. However,
any sperm containing a Y chromosomal microdeletion will be transmitted
to the offspring. Thus the risk that male offspring might later manifest
disorders including infertility is very real. However, men without a detectable
deletion by blood testing can generate offspring having a Y chromosome
microdeletion, because the chromosomes in the sperm may not be the same
as those seen when tested by a blood test.