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Intracytoplasmic sperm injection, or ICSI for short, is a special form of in vitro fertilisation (IVF). In a laboratory, one sperm is injected directly into the cytoplasm of an egg. For this reason, this method is also known as micro injection. It has been used successfully since 1992. If the quality of a man’s sperm is severely impaired, this procedure is often the only way for a couple to have their own genetic child.
ICSI can be used if
• a man’s fertility is so severely impaired that his sperm cannot fertilise the eggs independently, or
• previous attempts at conventional IVF have failed.
Just like conventional IVF, multiple eggs should be matured at the same time when using ICSI. This procedure is therefore usually performed in combination with hormone treatment for the woman.
Once the eggs have matured, a doctor removes them by means of so-called follicular aspiration. The doctor uses a thin needle with ultrasound guidance to collect the eggs from the woman’s ovaries. This procedure takes only a few minutes and is usually performed under brief anaesthesia. The retrieved eggs are taken to the IVF laboratory immediately after removal, where they are then prepared for fertilisation.
The man’s sperm sample is taken close to the time of egg retrieval. The sample is then prepared in the laboratory, to ensure that there are as many good-quality sperm as possible for the ICSI.
In the IVF laboratory, an expert injects an individual sperm directly into each egg (ICSI) using a special glass cannula under a microscope. The injected eggs are then immediately put in an incubator. The day after the ICSI, it is possible to see how many of the treated eggs have been fertilised (pronuclear stage). The further development into embryos also takes place in the incubator (maximum of 5 days).
Just like in conventional IVF, the doctor performs the embryo transfer to the woman’s uterus in consultation with the patient. To do this, the doctor uses a soft plastic catheter, and the procedure takes just a few minutes. The embryos can then implant in the lining of the uterus where they can continue to develop.
A pregnancy test can be done around 14 days later. This will then reveal whether the procedure was successful or needs to be repeated.
The success rates of ICSI depend largely on the age of the woman. For women up to 30 years of age, the rate of success is around 40 per cent, and for women from 30 to 39 years of age it is around 30 to 35 per cent. This means that around one in three treatment cycles leads to pregnancy.
ICSI entails similar risks to IVF. For example, the hormone treatment can cause hyperstimulation syndrome. This is manifested in abdominal pains, nausea or shortness of breath, for example. During follicular aspiration organs may also be injured accidentally. And anaesthesia is never entirely risk-free. As several embryos are usually inserted in the uterus in ICSI, the risk of multiple pregnancy is increased. The doctor will discuss the details with you during your individual consultation.
In Germany, statutory health insurance companies generally cover 50 percent of the costs of ICSI under very specific conditions, but usually only for three attempts.