ICSI, or intra-cytoplasmic sperm injection, is a technique developed to help achieve fertilization for couples who have had failure to fertilize in a previous IVF attempt or couples with severe male infertility.
Watch an educational clip on understanding ICSI and IMSI procedures from Fertility Clinic Nadiya documentary.
How is ICSI performed?
The first stage (ovarian stimulation) is the same as for standard IVF. Drugs for ovarian stimulation will be prescribed to the woman, and several mature eggs retrieved from her ovaries. Before eggs are incubated in the embryology laboratory, their quality is examined under the microscope. Male partner will be required to produce a sperm sample. The healthiest spermatozoon for intracytoplasmic sperm injection is selected during sperm evaluation. Sperm preparation may also be obtained from frozen semen sample. ICSI involves extremely precise maneuvers using specialized micromanipulation tools and inverted microscope that enable embryologist to select and pick up a single live sperm in a tiny specially designed very delicate, sharp and hollow ICSI needle. This needle is then carefully advanced directly into the center of a egg through the outer shell of the egg and egg membrane. Thereafter, the sperm is then injected into the cytoplasm of the egg. Next day the eggs are examined for the signs of fertilization. Then the fertilized embryos develop for further 24-48 hours. Any excess embryos of suitable quality are then undergone cryopreservation for later embryo transfer.
Pregnancy Outcome in IVF and ICSI.
ICSI success rates vary according to the ICSI technique used, the specifics of the individual case, the quality of the eggs, and the embryo transfer skills of the embryologist performing ICSI. At Nadiya Fertility clinic the pregnancy success rate of IVF and ICSI at 2008 for woman of all age group is 41.9% (21.2% in the UK), for woman over 42 years - 21,1% (5.2% for this age group in the UK).
A new fertility technique called IMSI (intra-cytoplasmic morphologically-selected sperm injection) can significantly increase the pregnancy success rate. When ICSI is used in the ordinary way, one sperm is taken from the male partner after routine selection under a regular microscope that magnifies it 200 to 300 times. In IMSI, the man's sperm sample is examined through high power light microscopy, which multiplies the image of individual sperm up to 6000 times. This makes it possible to discard sperm whose nuclei have an abnormal shape or contents and is thus, much less likely to produce a healthy embryo. Only those spermatozoans which appear have "good" genetic characteristics are selected for IMSI with a good chance of developing properly in the uterus.
Pregnancy Outcome in IVF and IMSI.
“Reproductive Biomedicine Journal” published research demonstrating that the IMSI technique can considerable increase the pregnancy rate. The overall pregnancy rate for the ICSI group was 26.5%, compared with 39.2% for the IMSI patients. Among men with the worst prognosis, who had at least two failed attempts at ICSI before, the improvement was better still. The pregnancy rate for standard ICSI was 1 12.9%, compared with 29.8% for IMSI. The miscarriage rate also fell considerably.
IVF Treatment 
