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ICSI may be utilized for many etiologies of infertility. Typically, ICSI is used for male factor infertility, which may take several forms, oligozoospermia (few sperm), asthenozoospermia (poor motility), teratozoosperma (abnormal morphology) or a combination of all three. Additionally, ICSI may be necessary following a vasectomy reversal, in which the male partner has developed antisperm antibodies. ICSI is also indicated for couples that have normally appearing gametes, but who have experienced failed fertilization in a previous IVF cycle.
With ICSI, few sperm are necessary, basically a “few” more than the number of oocytes (eggs). However, live sperm are necessary for fertilization to occur.
In addition to utilizing ejaculated sperm for the ICSI procedure, sperm may be recovered from testicular tissue. We have developed a successful method to obtain testicular tissue in an in-office procedure. Fertilization of oocytes, embryonic development and pregnancy rates utilizing sperm extracted from testicular tissue are not different from those utilizing ejaculated sperm.
The ICSI procedure utilizes microscopy and micromanipulation. One sperm is loaded into a fine glass needle, the oocyte is penetrated and the sperm expelled into the cytoplasm of the ooctye. ICSI bypasses those barriers which normally permit only one sperm to enter the oocyte. Therefore, embryonic growth and development are not different from those of IVF embryos. To date, there have been no differences observed in minor or major malformations of ICSI babies when compared to IVF or naturally conceived babies.
ICSI appears to be a safe and effective method of Assisted Fertilization, allowing couples to have their own genetic child.