ICSI stands for Intracytoplasmic Sperm Injection, a specialized form of in vitro fertilization (IVF) that is primarily used to treat severe cases of male infertility. Here is an overview of the process and its key aspects:

 Step-by-Step ICSI Procedure:

1. Ovarian Stimulation

   – Medications: The female partner receives hormonal medications (gonadotropins) to stimulate the ovaries to produce multiple eggs.

   – Monitoring: Frequent blood tests and ultrasounds monitor the growth and development of the ovarian follicles.

2. Egg Retrieval

   – Trigger Injection: When the follicles are ready, a trigger injection (hCG) is given to mature the eggs.

   – Procedure: Approximately 36 hours after the trigger injection, eggs are retrieved from the ovaries using a fine needle under ultrasound guidance. This is done under sedation or light anesthesia.

3. Sperm Collection

   – Sample Collection: The male partner provides a semen sample on the day of egg retrieval.

   – Sperm Preparation: The semen sample is processed to isolate the healthiest and most motile sperm.

   – Surgical Sperm Retrieval (if necessary): In cases of azoospermia or other issues, sperm may be surgically retrieved from the testicles or epididymis (e.g., via TESE or MESA procedures).

4. Sperm Selection

   – Microscopic Examination: Under a high-powered microscope, an embryologist selects a single healthy sperm to inject into each mature egg.

5. Microinjection

   – Injection: Using a specialized microscope and micromanipulation tools, the selected sperm is injected directly into the cytoplasm of each mature egg.

6. Fertilization and Embryo Culture

   – Incubation: Injected eggs are placed in a culture medium and incubated to allow for fertilization and early embryo development.

   – Monitoring: Embryologists monitor the fertilized eggs to assess their development, typically over 3 to 5 days.

– Multiple Embryos: To increase the chances of success, multiple embryos may be transferred, which can lead to a higher likelihood of multiple pregnancies (twins, triplets, etc.).

– Risks: As with any medical procedure, there are risks involved, including ovarian hyperstimulation syndrome (OHSS), infection, or complications from egg retrieval.

 Summary:

The ICSI procedure is a meticulous and technologically advanced process that can significantly increase the chances of fertilization in cases of severe male infertility. By directly injecting a single sperm into each egg, ICSI bypasses many of the natural barriers to fertilization, providing couples with a viable path to achieving pregnancy.

– Severe Male Factor Infertility: Low sperm count, poor sperm motility, or abnormal sperm morphology.

– Previous IVF Failure: When conventional IVF has not resulted in fertilization.

– Sperm Retrieval: When sperm must be retrieved surgically due to blockage or absence of the vas deferens.

– Use of Frozen Sperm: When sperm quality is compromised due to freezing.

– Genetic Concerns: Slightly higher risk of genetic abnormalities compared to natural conception.

– Multiple Pregnancies: Higher likelihood if multiple embryos are transferred.

– Ovarian Hyperstimulation Syndrome (OHSS): A potential risk associated with the medication used to stimulate egg production.

– Increased Fertilization Rates: Especially in cases where male infertility is a significant factor.

– Allows Use of Low Sperm Counts: Effective even with very few viable sperm.

– Applicable to Many Conditions: Useful for couples with unexplained infertility or previous fertilization issues.

ICSI has revolutionized fertility treatment, providing hope for couples facing severe male infertility and improving the chances of achieving a successful pregnancy.

Before and after ICSI treatment, careful preparation and follow-up care are crucial to maximize the chances of a successful pregnancy. Here’s a detailed guide on the care required at each stage:

1. Medical Evaluation and Counseling:

   – Initial Consultation: Meet with a fertility specialist to discuss medical history, previous fertility treatments, and the ICSI process.

   – Diagnostic Tests: Both partners may undergo various tests, including semen analysis, blood tests, ultrasound scans, and genetic testing.

   – Counseling: Psychological support and counseling may be offered to help manage the emotional aspects of the treatment.

2. Lifestyle Modifications:

   – Healthy Diet: Focus on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains.

   – Avoid Alcohol and Tobacco: Both partners should avoid smoking and drinking alcohol.

   – Exercise: Regular moderate exercise is beneficial but avoids intense physical activity.

3. Medications and Hormonal Treatments:

   – Ovulation Induction: The female partner may receive medications to stimulate the ovaries to produce multiple eggs.

   – Monitoring: Frequent visits to the clinic for blood tests and ultrasounds to monitor egg development.

1. Egg Retrieval:

   – Procedure: The eggs are retrieved from the ovaries under sedation or anesthesia.

   – Recovery: Rest for the remainder of the day and avoid strenuous activities.

2. Sperm Collection:

   – Sample Collection: The male partner provides a semen sample on the day of egg retrieval.

   – Sperm Retrieval Techniques: In cases of azoospermia, sperm may be surgically retrieved.

3. ICSI Procedure:

   – Laboratory Process: The selected sperm is injected into the eggs in a lab setting.

   – Monitoring: The fertilized eggs (embryos) are monitored for development.

4. Embryo Transfer:

   – Procedure: After a few days of development, the best quality embryo(s) are transferred into the woman’s uterus.

   – Rest: Short rest period following the transfer; normal activities can typically be resumed the next day.

1. Post-Transfer Care:

   – Medications: Continue prescribed medications, such as progesterone, to support the uterine lining.

   – Activity Level: Avoid heavy lifting and strenuous exercise; light activities are usually fine.

2. Monitoring and Follow-Up:

   – Pregnancy Test: Typically performed about two weeks after embryo transfer to check for pregnancy.

   – Ultrasound: If the pregnancy test is positive, an ultrasound will confirm the location and viability of the pregnancy.

3. Managing Side Effects and Complications:

   – OHSS: Watch for symptoms of Ovarian Hyperstimulation Syndrome, such as abdominal pain, bloating, and nausea.

   – Emotional Support: Consider ongoing counseling or support groups to manage the emotional aspects of the process.

4. Healthy Pregnancy Maintenance:

   – Regular Prenatal Care: Schedule regular check-ups with an obstetrician to monitor the pregnancy.

   – Lifestyle: Maintain a healthy lifestyle with a balanced diet, prenatal vitamins, and appropriate exercise.

1. – Stay Informed: Understand each step of the ICSI process and follow your clinic’s instructions carefully.- Emotional Well-being: Stress management techniques, such as yoga, meditation, and support from family and friends, can be beneficial.- Communication: Maintain open communication with your fertility specialist and healthcare team.Proper care before and after ICSI can significantly impact the treatment’s success and the health of both the mother and the baby.

Indications

Procedure

Success Rates

Cost

Natural selection of sperm by the egg

Broad range of infertility issues, including mild male factor infertility

Eggs and sperm are mixed in a petri dish for natural fertilization

Dependent on natural fertilization process

Generally lower than ICSI

Direct injection of a single sperm into the egg

Severe male factor infertility, previous IVF failure, genetic concerns

A single sperm is injected directly into the egg

Higher fertilization rates in severe male infertility cases

Generally higher due to the additional step of sperm injection

In summary, while both IVF and ICSI are effective fertility treatments, the choice between them often depends on the specific infertility issues faced by the couple. IVF is suitable for a broad range of fertility problems, whereas ICSI is particularly advantageous for addressing severe male infertility.

The cost of Intracytoplasmic Sperm Injection (ICSI) varies significantly across different countries due to various factors such as the cost of living, medical infrastructure, and the expertise of healthcare professionals.

Cost of ICSI in Iran

In Iran, the cost of ICSI is approximately $3,500 per cycle. This price is considered very affordable compared to many other countries. Iran also offers high-quality medical facilities, experienced professionals in clinics and hospitals, and a success rate of over 60%, making it an attractive destination for couples seeking fertility treatments.