Center for Advanced Reproductive Care: CARC

Information Summary for Intracytoplasmic Sperm Injection (ICSI)

A technique called intracytoplasmic sperm injection (ICSI) is used to assist fertilization for couples with male-factor infertility that is unresponsive to other clinical and laboratory forms of treatment. The procedure involves injecting a single, live sperm directly into a mature oocyte. We recommend ICSI for couples who have no or very low rates of fertilization during previous treatment cycles or when the number of normal motile sperm available is less than that required for standard IVF procedures. The American Society for Reproductive Medicine recognized ICSI as a standard clinical technique for assisting fertilization in 1994.

The University of Iowa's Center for Advanced Reproductive Care (CARC) performed their first ICSI procedure in February 1994. The birth resulting from ICSI performed at the CARC occurred November 1994 November 15, 1994. During the past two years (January 2001 - March 2003), the CARC has performed ICSI during 371 in vitro fertilization procedures. Both the fertilization rate, which is the number of eggs that fertilize divided by the number of eggs injected, and the clinical pregnancy rate per egg retrieval, which is the presence of a gestational sac observed by ultrasound, vary with the egg quality, the age of the woman from which the eggs are retrieved and the method of sperm retrieval. The fertilization rate for each sperm retrieval method as well as the clinical and ongoing pregnancy rates for each female partner age group are shown in the table below.

It has been our experience, and the experience of programs around the world, that oocytes fertilized after insemination by ICSI with sperm from an ejaculate or from an epididymal aspirate are equal in quality and viability and are capable of implanting in the uterus with the same frequency as oocytes fertilized after conventional in vitro insemination techniques. Furthermore, the pregnancy, miscarriage and delivery rates following transfer of oocytes fertilized after insemination by ICSI are similar to the outcomes following transfer of fertilized oocytes inseminated by conventional in vitro insemination techniques. We also have found that oocytes fertilized after insemination by ICSI survive cryopreservation just as well as fertilized oocytes that had been inseminated by conventional in vitro insemination techniques. Please refer to our program's procedure outcome data for additional outcome data for your specific age group.

ICSI with sperm isolated from testicular biopsies results in lower fertilization rates and pregnancy rates than when ICSI is performed with sperm isolated from an ejaculate or epididymal aspirate. This trend has been reported by the majority of infertility clinics and is thought to be due to the nature of the infertility diagnosis that requires sperm isolation from testicular biopsies rather than the sperm retrieval method.

RISKS

There is a risk of oocyte damage and degeneration due to the injection procedure. Up to 5% of the oocytes that are subjected to ICSI may not survive the injection and will degenerate. Oocyte damage is easily recognized as the oocyte will darken either immediately following ICSI or will appear as degenerated at the time of fertilization confirmation approximately 16 hours after ICSI.

ICSI is a more invasive procedure than conventional in vitro insemination. Since its inception in 1992, there have been concerns about the safety of ICSI since fertilization usually results from injection of sperm that, if unassisted, would not be capable of achieving fertilization. The percentage of babies born with major congenital abnormalities does not appear to be influenced by the insemination method used during an in vitro fertilization procedure. The Belgian program that developed the ICSI technique reported that 3.4% of their 2840 ICSI babies and 3.8% of their 2955 babies resulting from conventional in vitro fertilization had major congenital abnormalities that required medical intervention.

While the frequency of birth defect and chromosome abnormalities in children conceived from ICSI appears to be similar to children conceived following in vitro fertilization with conventional insemination, couples that use ICSI for the treatment of their infertility must be aware that the ICSI data is based on a relatively small number of pregnancies and children. It also is important to realize that not all genetic abnormalities may be recognized at birth. Small, subtle mutations or disturbances in the genetic code may be passed on to offspring. The consequences of these mutations are unknown, but may include infertility for future generations.

Incorporating ICSI Into Your Consent

If ICSI is recommended to assist fertilization, the physician signing consents with you will ask you to initial the paragraph requesting ICSI. In order to complete the embryo transfer/cryopreservation table, you must consider the number of oocytes anticipated. You should anticipate that oocytes will be recovered from 75% of the follicles over the size of 10 mm. Approximately 80% of the oocytes will have completed maturation at the time of insemination. All mature oocytes can be inseminated by ICSI. Immature oocytes cannot be inseminated by ICSI. The following example is based on our program's average oocyte recovery, maturity and ICSI fertilization rate. It is our hope that this example will prove to be helpful for completing your consents. Oocyte recovery, maturity and fertilization rates will vary patient-to-patient and cycle-to-cycle. The following is only an example.

Example:

16 follicles >10 mm X 75% recovered = 12 oocytes

12 oocytes recovered X 80% mature = 10 (9.6) oocytes for injection

10 oocytes injected X 70% fertilize = 7 embryos

You will be charged a fee for the ICSI procedure. Please refer to your fee schedule for the current ICSI fee. ICSI will not be performed without your written consent. Questions about this procedure will be answered by our embryologists: Amy Sparks, PhD, Patty Nolan, BS or Melody Bakken, BA, Department of Obstetrics and Gynecology (319-384-8354). If you would like to meet with one of our embryologists to discuss ICSI or any other laboratory-related issues, please notify an IVF clinic staff member. The IVF clinic will be happy to schedule a laboratory consult to coincide with one of your clinic appointments.

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