ICSI Full Form

Intracytoplasmic sperm injection is an IVF procedure that involves injecting a single sperm cell directly into the cytoplasm of an egg. This method is used to prepare gametes for the creation of embryos that can be transferred to the uterus of a mother. The acrosome reaction is bypassed with this method.

There are a few distinctions between traditional IVF and ICSI. The steps to take before and after insemination, however, are the same. ICSI requires only one sperm cell per oocyte for insemination, whereas IVF requires 50,000–100,000. This is because IVF necessitates the acrosome reaction and the involvement of thousands of sperm cells. The egg becomes a proembryo after it has been fertilised.

Indication

This procedure is most commonly used to treat male infertility, but it may also be used in cases where sperm cannot easily penetrate eggs and in conjunction with sperm donation. 

It can be used in teratozoospermia because abnormal sperm morphology does not appear to affect blastocyst development or morphology once the egg is fertilised.

Microscopy can detect the few sperm cells with a “normal” morphology even in severe teratozoospermia, allowing for an optimal success rate. 

In addition, we use ICSI to treat azoospermia (a condition in which no spermatozoa are ejaculated but are present in the testis), various spermatozoa (sperm samples taken to preserve fertility after chemotherapy), and previous irruptions in IVF cycles.

History

In April 1989, a child born from gamete micromanipulation (a technique in which embryologists use special tools and inverted microscopes to help them choose and pick individual sperm for ICSI IVF) was born in Singapore.

Gianpiero Palermo developed the technique at the Vrije Universiteit Brussel’s Center for Reproductive Medicine, which is led by Paul Devroey and Andre Van Steirteghem.

The discovery was actually made by accident.

In the case of male infertility, the woman bears the treatment burden, which is an unusual situation in medical practice. The success of ICSI has effectively shifted attention away from determining what causes male infertility and toward optimising the provision of eggs and a receptive endometrium, which ICSI relies on.

Procedure

• Under a microscope, the technique is carried out with a variety of micromanipulators (micromanipulator, microinjectors, and micropipettes)
• The mature oocyte is held in place by a holding pipette with mild suction provided by a microinjector
• After immobilising the sperm with the tip of the micropipette, a thin, hollow glass micropipette is utilised from the opposite side to capture a single sperm
• After the egg is punctured through the oolemma, the sperm enters the oocyte’s interior (cytoplasm). Sperms are released into an egg after that
• The oocyte has an extended polar body about 12 o’clock, which indicates maturity 
• When inserting a micropipette into an egg, the polar body should be placed around 12 or 6 o’clock to avoid disrupting the spindle. Next day, the egg will be examined for evidence of fertilisation in cell culture
• During zona pellucida and lemma breaking, small mechanical pulses (Piezo-pulses) are employed in a novel version of the normal ICSI process known as Piezo-ICSI to lessen the stress on the cytoskeleton of the developing embryo
• The process employs customised Piezo actuators, microcapillaries, and filling fluids to deliver mechanical pulses to cell membranes. Animal ICSI and animal ES cell transfer were pioneered by the Piezo method 
• The male partner or a donor supplies a sperm sample on the same day as the eggs are taken. Medics will extract sperm from the epididymis or testicle if no sperm were identified in the sample
• Aspiration of sperm from the epididymis and the testicles are both called percutaneous epididymal sperm aspiration and testicular aspiration, respectively
• It is possible to wash or capacitate the total spermatozoa in the semen sample, depending on the total spermatozoa in the sample

Complications

• Although different studies show contradictory results, there is some evidence that IVF in general, and ICSI in particular, increases congenital disabilities
• The Practice Committee of the American Society of Reproductive Medicine stated in a summary position paper that ICSI is a safe and effective treatment for male factor infertility
• It may increase the risk of certain genetic abnormalities being transmitted to offspring, either through the procedure itself or through the increased inherent risk of such abnormalities in parents undergoing the procedure

Conclusion

Intracytoplasmic Sperm Injection (ICSI) is a procedure in which a single sperm is injected into each egg to aid fertilisation using very fine micro-manipulation equipment as part of an IVF treatment cycle. ICSI can usually be used to treat severe male infertility.

Fertilisation rates of 70 to 80 percent of all eggs injected are currently being achieved, which is equivalent to fertilisation with normal sperm, and pregnancy rates are comparable to those seen with IVF in couples with no male factor infertility.