When it comes to fertility treatment, the focus is predominantly on women … the intrusive tests, the endless injections, the constant scans and the tears that go hand in hand with raging hormones, uncertainty, fear and angst.
We wrap ourselves up in the virtual blanket of social media support groups and discuss our innermost feelings with other women. In the process, the fact that men are as likely to be infertile as women is passed over, barely getting a mention…let alone a discussion.
But what do the guys do? Who are they talking to? Where are they turning for information?
We want to arm our men with as much information as possible on their journey of infertility treatment, so over the month of February, we will be turning our attention to the male partners.
This week, along with many readers, we wanted to understand more about ICSI as a fertility treatment and so we turned to Dr. Manish Banker, Director of Nova IVI Fertility, to explain exactly what it is.
What is ICSI?
ICSI stands for Intracytoplasmic Sperm Injection. It is a procedure that is mainly used when the man’s sperm is low in numbers or quality. ICSI is advised for all male infertility cases, since only the best and the healthiest sperm is used for fertilisation.
What is the difference between ICSI and IVF?
While most of the procedure is identical – ovarian stimulation, ovum pick up, sperm collection and preparation – there is a vital difference between the two. In IVF – in-vitro fertilisation – the washed sperms and the retrieved oocyte (egg) are placed in a culture medium in a glass dish. One sperm penetrates the outer layer of the oocyte, and then fertilises it.
In ICSI, a single, carefully-selected sperm is injected with a very thin glass needle into the oocyte. Before the sperm is injected, a part of the outer layer of the oocyte is stripped off.
Does ICSI have a higher success rate?
Studies have shown that in cases where the man’s sperm is normal, there is no advantage to having ICSI over IVF. However, in cases of low sperm count, motility and morphology, repeated IVF failures, and where frozen sperm is being used for treatment, ICSI is the best treatment option. ICSI is often done in conjunction with surgical procedures for sperm retrieval in cases where no sperms are found in semen.
Why is IVF sometimes recommended for men with defective sperm? Isn’t it a waste?
Both IVF and ICSI require great care and well-trained embryologists, as well as superior equipment and facilities to be carried out. Some doctors may not recommend ICSI for medical reasons, e.g. an older couple with more fragile eggs, the lack of technology to choose the most viable sperm, etc. There could be other reasons why a doctor recommends IVF instead of ICSI.
What is the cost difference between ICSI and IVF?
There’s no significant cost difference between ICSI and IVF.
What are the risks associated with ICSI?
Being a relatively complex procedure, there are chances that a small percentage of eggs, often the less healthy eggs, may be damaged by the ICSI procedure if not done meticulously (5-10%). Sometimes the eggs may fail to fertilise normally or arrest at an early stage of development.
Critical to the “riskiness” of ICSI is the quality of the sperm. Healthy sperm extracted surgically due to physical blockages will have far lower risks associated with the procedure (typically 0.2% more risks than IVF).
However, since many of cases in which ICSI is carried out are due to non-production of vigorous sperm or other genetic issues, the likelihood of the father passing on genetic defects to the child are higher. One way of reducing the likelihood of genetic defects in the child is to have the sperm or the embryo genetically tested before fertilisation or implantation respectively.
So should you consider ICSI?
It is reassuring to know that the procedure enjoys wide acceptance in the ART community as a breakthrough treatment that allows men who need special help in fathering a child.