ICSI & Male Infertility

Why ICSI may help those struggling with male factor infertility

While defining the cause of infertility is still hard in many cases, there are safe and effective treatments available that can help couples achieve a pregnancy.

Since the conception of the first baby in 1978, assisted reproductive techniques have gained popularity. The outcome of live births has improved over time. One of these techniques is intracytoplasmic sperm injection (ICSI), used for male factor infertility.

What Is ICSI?

Intracytoplasmic sperm injection or ICSI is a method of fertilization outside the human body. It involves isolating a live human sperm and injecting it into the egg using a micropipette.

It is different from in-vitro fertilization, commonly referred to as IVF, in which numerous sperm are allowed to fertilize the egg in a petri dish.

Unlike traditional in-vitro fertilization, ICSI does not rely on the natural ability of sperm. Instead, it involves taking one sperm and physically putting it inside the egg. This is why ICSI is generally reserved for male factor infertility.

How Does ICSI Work?

Male factor infertility, typically due to insufficient sperm parameters, can sometimes be overcome with ICSI. If the sperm are unable to fertilize the egg naturally, it may be due to any of the following reasons:

  • Sperm count is low
  • Sperm motility is non-progressive or lacks forward progression
  • Sperm have structural defects
  • Semen contains antibodies that may attack sperm cells and destroy them
  • Semen does not ejaculate due to structural defect in the male reproductive tract

Fortunately, several of these parameters may be identified in a simple in-home semen analysis test.

Intracytoplasmic sperm injection allows you to bypass some of this issues. A single sperm is taken and left inside the egg bypassing its outer coating. So, the sperm motility, sperm count, and semen abnormalities become less important.

In cases of retrograde ejaculation, where the semen goes into the urinary bladder instead of exiting the penis, it is possible to draw a sample from testicles directly using a needle.

Am I Eligible For ICSI?

ICSI may be suitable for other fertility situations in addition to poor sperm parameters.

Male Factor Infertility

If the sperm count or quality is low, IVF alone may not produce results. In some cases of infertility, some providers may recommend ICSI to maximize the possibility of fertilization. Since the cost of IVF and the failure rate is high, it makes sense to cover all the bases, especially if male factor infertility is the issue.

IVF Fails To Form An Embryo

The traditional in-vitro fertilization happens in a petri dish. Sperm and eggs are allowed to fertilize and form an embryo, which is then implanted in the womb (uterus).

If IVF fails and the egg does not fertilize despite an adequate sperm present, ICSI may prove beneficial. It is often done in conjunction with IVF to improve the chances of pregnancy.

Frozen Eggs Are Used

Eggs or oocyte freezing is a standard method to preserve eggs for future use. However they need to be thawed when you are ready to use them. Sometimes, this results in hardening of the outer covering of eggs.

It can be difficult for sperm to penetrate this hardened outer covering on their own, and intervention may be necessary. ICSI, along with IVF, may give you a better shot of fertilizing frozen eggs.

What Are The Limitations Of ICSI?

ICSI does come with some limitations and side effects; more research is needed in this area.

  • ICSI It is not a magic bullet—rather it is an attempt to increase the chances of fertilization. Injecting sperm does not always translate into a productive outcome.
  • Infants born using IVF or ICSI may have a higher risk of genetic problems compared to those born without assisted reproductive technology.
  • IVF and ICSI are costly; IVF up to $20,000, and ICSI costs around an additional $2000, as it is used in conjunction with IVF.

References

  1. Choe J, Archer JS, Shanks AL. (2022). In Vitro Fertilization. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562266/
  2. Palermo, G D et al. “Intracytoplasmic sperm injection: a powerful tool to overcome fertilization failure.” Fertility and sterility vol. 65,5 (1996): 899-908.
  3. Alukal, Joseph P, and Dolores J Lamb. “Intracytoplasmic sperm injection (ICSI)--what are the risks?.” The Urologic clinics of North America vol. 35,2 (2008): 277-88, ix-x.
  4. Palermo, G D et al. “Intracytoplasmic sperm injection: state of the art in humans.” Reproduction (Cambridge, England) vol. 154,6 (2017): F93-F110.