ICSI treatment in India

ICSI treatment in India

Until the 90’s, males with very low sperm count (less than 5 million per ml) or with poor quality sperms had no hope of fathering their own genetic children. This problem was outdone by new breakthrough, I.C.S.I. (Intra-cytoplasmic Sperm Injection) an ART Treatment which took place in Brussels and Belgium in 1992.

Since then, many such patients with poor sperm count or with low quality sperm have been able to father their own genetic child. In KIC, we started our own ICSI programmed in 1998-99 and till date more than 10,000 cycles of IVF or IUI with ICSI have been undertaken with an approximate success rate of around 40% to 50% in each cycle, which is at par with the best success percentages in this treatment across the globe.

In ICSI, all the steps are similar to that in the IVFprocedure, except the step of fertilization. Normally in IVF, extracted sperms which are around or more than 200,000 and allowed to mate with one egg and among these, one of the sperm fertilizes the egg on its own. In contrast to this, while undertaking ICSI, each egg is held and injected with a single live sperm. This micro-fertilization is done with the help of a machine called the Micromanipulator. The procedure can be categorized into 11 steps as discussed below.

 

Thus the procedure consists of:

ICSI treatment in India

  • Controlled Ovarian stimulation with drugs like (GnRH) Analogues and Gonadotrophins to produce many eggs.
  • Monitoring of follicles and egg development with the aids like Vaginal Sonography and serial Estradiol hormone estimation through blood samples.
  • Administering of HCG injection, (Human Chorionic Gonadotrophins) when at-least two leading follicles which are 18 mm in diameter.
  • Egg retrieval under general anaesthesia, approximately after 32 to 36 hours after HCG injection
  • Identification and isolation of healthy eggs in the laboratory.
  • Sperm collection and processing in the lab. (In case of Azoospermia {no sperms in the semen} the sperms are collected directly from the testes with the procedures of PESA/MESA/TESE or TESA.)
  • Stripping of the cumulus of the eggs in the laboratory with the help of an enzyme.. Placement of eggs into small droplets of culture media under oil.
  • Placing sperms into small droplets of PVP under oil. Immobilization of the sperm with a micro injection needle (Diameter of 7 microns) and aspiration of the immobile sperm into the needle after crushing the tail portion of the sperm).
  • Holding the egg with a holding pipette and injecting of immobilized sperm into the held egg.
  • Placement of these eggs into the incubator for 2 to 5 days.
  • Embryo formation 2 to 5 days after fertilization.
  • Embryo transfer of good quality embryos back to the womb, on day-2 (four cell embryo), day-3 (6 to 8 cell embryo) or day-5 or 6 (Blastocyst stage) days after egg removal.

Indications for ICSI

  • Males with severe sperm factors such as low sperm count (less than 5 million), very poor motility or a high degree of abnormal sperms.
  • In Azoospermia Condition, where there is no sperm present in the semen. Azoospermia may be of the obstructive type where there is a production of sperms in the testis but blockage of the conduction system, which brings the sperm out into the semen. Alternately, in Azoospermiacondition may be of the non-obstructive type, where there is a failure of the testes to produce sperms. In current scenario, in both these conditions, sperms can be isolated directly from the testis by Testicular Biopsy.
  • Retrieval Techniques of PESA/TESA/TESE and subsequently, ICSI can be performed on the following cases: • Males with sperm anti-bodies.
    • Males with sperm-antibodies,
    • Males with Sperm Ejaculated Dysfunction due to Spinal injury or malfunction such as Quadriplegics or Paraplegics.
    • Patients with Retrograde Ejaculation (ejaculation of the sperm into the urinary bladder) who fail to become pregnant with IUI.
    • Patients where fertilization has failed with In-Vitro Fertilization.

 

In KIC, we also suggest ICSI on patients who have had a previous history of Tuberculosis or Endometriosis, as with our past experience, we are of a view that it has an opportunity of better fertilization rates than standard IVF procedure, but there are not enough studies reflecting this phenomenon.

Many units who have cropped up recently due to the lucrative market of infertility treatment without experience advocate I.C.S.I. for all patients, including those with normal sperm count. We at KIC do not undertake this and suggest I.C.S.I. only if it is deemed to be necessary as we believe that pregnancy should be achieved with minimum handling of the gametes outside the body and if the sperm count is good enough for fertilization with IVF, then there is no reason to do I.C.S.I. until it is deemed necessary by other indications. However, if a particular patient has a sperm count, which is in the grey-zone area, then we may subject half the eggs to IVF and half the eggs to ICSI.