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ICSI

An intracytoplasmic sperm injection (ICSI) treatment is a special kind of IVF treatment. During an ICSI procedure, which takes place in a laboratory, a sperm cell will be injected directly into the oocyte – more precisely, into its cytoplasm. This is the reason why this method is also known as micro-injection. ICSI treatments have been taking place successfully since 1992. You have an indication for this treatment if your decreased fertility as a couple is the result of sperm cells that are incapable of fertilizing ova spontaneously.

 

 

Reasons to do an ICSI treatment

We offer the possibility of an ICSI treatment if:

  • The man’s fertility is reduced so much that his sperm cells are unable to fertilize the egg cell on their own, or
  • No fertilization occurred in a previous IVF treatment, or
  • The sperm cells that are being used were acquired through a TESE or PESA treatment.

What is the timeline of an ICSI treatment?

1. Hormonal stimulation

Similar to an IVF treatment, an ICSI treatment requires the maturation of several oocytes at the same time, since that increases the odds of a successful treatment. Multiple oocyte maturation is stimulated through a hormone treatment.

Obtaining and preparing the oocytes

As soon as the oocytes have matured fully, your treating nurse or physician will use a hollow needle to suck them out, while monitoring the procedure using an ultrasound. This is called an oocyte retrieval. An oocyte retrieval will generally take mere minutes. During this procedure, we offer the possibility of taking painkillers intravenously. Thank to this, most women find this procedure relatively easy to endure. After the retrieval, the obtained oocytes will be taken to our laboratory immediately, where they’ll be prepared for fertilization.

2. Obtaining sperm from the biological father

The sperm sample delivery will take place shortly before or after the oocyte retrieval. Afterwards, the sample will be processed in our laboratory to ensure that the maximum number of high quality sperm cells possible will be available for the ICSI. If the ejaculate does not contain any sperm cells, we can use material obtained from a testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESE). If the male partner has no viable sperm cells, we also offer the possibility of using sperm from a sperm bank or a personal, known donor, such as (for example) a family member.

3. Fertilizing the oocytes in the laboratory

One of our experts will, in our laboratory, use a microscope and a special needle to inject a single sperm cell directly into an oocyte. This procedure is known as an ICSI. The day after the ICSI we’ll be able to tell how many of the oocytes we injected have been successfully fertilized. This is known as the pre-nucleus stage. Developing the successfully fertilized oocytes into embryos will take place in a special incubator, and will take five days maximum.

4. Transferring the embryo into the uterus

A physician will use a smooth, flexible catheter to place an embryo into the uterus. The treatment itself will only take a few minutes. Usually, we’ll only transfer a single embryo at a time. Depending on the age of the hopeful mother and the number of previous (failed) IVF/ICSI treatments, we may occasionally choose to transfer two embryos instead. After being transferred, the embryo can start to lodge in the endometrium and start the next stage of its development.

After roughly 14 days, you’ll be able to perform a pregnancy test to determine whether the treatment was successful or will need to be repeated.

What are the odds of success in an ICSI treatment?

For an ICSI treatment, the odds of conceiving and carrying the pregnancy to term largely depend on the mother’s age. The success rate of an ICSI in 30-year-old women is roughly 30-40% for each embryo transfer. In 40-year-old women, the success rate is roughly 10%. This means that on average, one in three procedures will lead to a successful pregnancy.

What risks are associated with an ICSI treatment?

An ICSI treatment involves roughly the same risks as an IVF treatment. All complications detailed below are rare, but they may certainly be severe in those individuals that do encounter them. The hormone treatment may have complications such as tiredness, mood swings, headaches and bloating/feeling bloated. Overstimulation syndrome is another complication of a hormonal stimulation which may occur after an oocyte retrieval. It involves symptoms like abdominal pain, headaches, nausea, shortness of breath and/or weight gain. 

After an oocyte retrieval, (re)bleeding or an infection may occur in very rare cases. The physician treating you will inform you extensively regarding the possibilities and risks of the treatment, explain the timeline and talk you through the possibility of developing a multiple pregnancy.

These details will be talked about during an individual advisory consultation.

Will the costs of an ICSI treatment be covered by insurance?

In the Netherlands, IVF/ICSI treatments are covered by basic insurance. Basic insurance will cover three complete IVF/ICSI treatments. One IVF/ICSI treatment consists of the hormonal stimulation, the oocyte retrieval, and the transfer of all resulting embryo into the uterus.