Conventional In Vitro Fertilization (IVF) involves placing several thousands of sperm cells and eggs together in a laboratory culture dish, allowing the sperm to fertilize the eggs. For most patients with normal semen analysis parameters, conventional IVF fertilization rate is roughly 65-70%. For patients with abnormalities on semen analyses, the technique of intracytoplasmic sperm injection (ICSI) is used to assist fertilization. This method of fertilization has been used in human IVF since the early 1990s. ICSI is now recognized as a standard clinical technique and is now a component of in vitro fertilization (IVF), and is no longer considered experimental.
There had been reports on increased risk of congenital malformations associated with ICSI, compared to those associated with conventional IVF cycles, but they have yielded conflicting results. Several other studies have supportively demonstrated the efficacy and short-term safety of ICSI.
ICSI has dramatically changed the treatment of male factor infertility. The fertilization rate with ICSI is about 70% regardless of the severity of the male factor. This technique is used for men with severely depressed sperm parameters, men with absent or blocked vas deferens, in cases where sperm need to be obtained from the epididymas or testicle, and in cases with history of failed fertilization with conventional IVF. It is also utilized for the treatment of infertility due to selected female factors such as morphologic anomalies of the oocyte, limited quantities of oocytes, and anomalies of the zona pellucida. The pregnancy rates with IVF/ICSI are the equivalent of those couples without male factor infertility who undergo conventional IVF.
In addition, ICSI may be needed for IVF treatment if polyspermia or poor fertilization occurred in a prior cycle where insemination alone was used or if preimplantation genetic diagnosis (PGD) is planned, especially for single gene defects.
Here at Laurel Fertility Care, we are possibly the first, and only, IVF program in the Bay Area to utilize a new device called an Oosight into our routine IVF laboratory. The Oosight, also known as a polscope, is installed on a high resolution microscope and allows the observer to identify the presence of the meiotic spindle that is associated with the chromosomes in the nucleus of the egg. Using the Oosight, we can determine where the nucleus of the egg is when we perform ICSI. This enables us to be much more precise and careful that we aren’t disrupting the nucleus during injection of sperm into the egg.
Male partners with vasectomies or very low to no sperm counts can still biologically participate in fertility care. In such cases, we work closely with reproductive urologists to gently extract sperm directly from the testes. This is a minimally invasive outpatient procedure. Sperm collected in this fashion can be used immediately with ICSI or frozen for future use.