Intracytoplasmic sperm injection is one of the most advanced technique introduced in artificial reproductive Technology.

Definition- In this technique single spermatozoa is injected directly into the cytoplasm of one egg tomake the fertilization.

History of ICSI

The usual IVF method gives a fertilization rate between 50 to 70%. In the case of severe male infertility where the count or motility is very low the conventional IVF technique gives poor outcomes in terms of< fertilization. ICSI was fast introduced in 1992. It is a one-stop solution for male factor infertility where one sperm is injected into an egg and the fertilization and pregnancy rates are high.

Indication of ICSI

Severe male factor infertility

  1. Severe oligospermia where the sperm count is less than 10 million/ml.
  2. Used in severe motility related issues (asthenozoopsermia)
  3. The morphology is very bad known as teratozoospermia(less than 4% structure is normal).
  4. Can also be used in case of obstructive azoospermia where we extract the sperm by percutaneous epididymal sperm aspiration for testicular sperm extraction, then will perform the ICSI in these cases.
  5. Also can be used in a frozen thoughts parm where the partner is not present during ovum pick up or it has been frozen due to fertility sparing issues.
  6. Previous fertilization failure with IVF.
  7. Oocyte abnormality like thick zona pellucida.
  8. In a case of plantation genetic testing
  9. HIV discordant couple

Steps of ICSI

  1. Setting up of a micromanipulator consist report a inverted microscope and to arrange the micropipettes better connected to the micro injector syringes 
  2. After ovum pick up we first scan the oocytes followed by putting it into an oocyte culture media and then delude it to make free of the cumulus complex to get the metaphase 2 oocyte which is a mature oocyte
    and is the preliminary prerequisite for performing ICSE, then we put it into the ICSI dish.
  3. Another most important crucial step is sperm selection.
  4. The final step is to do ooplasmic penetration (that is the cytoplasm of the oocyte) and sperm deposition. The microinjection pipette containing the sperm is pointed towards the egg and then it ispenetrated through the zona pellucida(outer hard covering of egg) at the 3 o’clock position.

Success of ICSI

Fertilization approximately 80% and clinical pregnancy rate of 42 -45%.