ICSI Treatment In India

ICSI (Intra Cytoplasmic Sperm Injection) – An Injection Of Hope

ICSI – Is It For Us?

Before making this crucial choice, the two of you should consider the following questions:

• Has the male partner’s sperm count been low?
• Is the sperm’s motility unusually low?
• Do the sperm cells have a healthy morphology?
• Has the male partner undergone vasectomy?
• Does the male partner have problems ejaculating or getting an erection?
• Does the male spouse suffer from diabetes, a spinal cord injury, or any other conditions that could interfere with reproduction?

If so, ICSI may be the answer you’ve been seeking for.

How Does the ICSI Procedure Work ?

The only difference between ICSI and IVF is the method of fertilisation. In IVF, the fertilisation process takes place in a disc, but in ICSI, each sperm is individually injected into each egg using a device known as a micromanipulator.

What Are The Steps Leading Up To ICSI?

For women :

• The administration of fertility medications like gonadotrophin.
• Eggs are gathered.
• Collected eggs are fertilised at low temperature by injecting them with clean, healthy, and very potent sperm.
• Transfer of the embryo to the uterus.

The steps for men are::

• Sperm suitability for fertilisation is evaluated.
• Individual sperm cells are injected into the egg from a sample collected naturally if appropriate sperm is available.
• If not, sperm is immediately removed from the epydidymis using a tiny syringe (a narrow tube inside the scrotum). This approach is known as PESA (percutaneous epididymal sperm aspiration). TESA, or testicular sperm aspiration, and TESE are further techniques.

What Are The ICSI Success Rates?

The success rates of more than 800 of these ICSI Procedures performed at Dr. Nandita Palshetkar‘s IVF facilities around India were estimated to be 40%, which is an injection of much-needed hope.

Intra Cytoplasmic Sperm Injection

Males with extremely low counts (less than 5 million per ml) or poor quality sperm had little chance of having children until the 1990s. The new ICSI discovery, which occurred in 1992 in Brussels, Belgium, solved this issue.

Since then, numerous patients of this type have fathered children. Since 1995–1996 when we began our own ICSI programme, we have completed more than 800 cycles with a success rate of 30–40%, which is equivalent to the finest units worldwide.

All of the steps in ICSI are comparable to those in IVF, with the exception of the fertilisation phase. One egg is often combined with 100,000 sperms during IVF, and one sperm fertilises the egg on its own. In ICSI, however, a single live sperm is kept and injected into each egg. The Micromanipulator, a device, is used to perform this micro-fertilization.

The Infertility India clinic offers thorough, reasonably priced ICSI therapy and services. ICSI Center in India, our facility provides ICSI treatment for infertility.

Thus the procedure consists of:

• controlled ovarian stimulation using medications (such as gonadotrophins and analogues of GnRH) to increase egg production.
• Utilizing serial Estradiol hormone estimation and vaginal sonography, one can track the growth of follicles and eggs.
• Human Chorionic Gonadotrophins (hCG) injections are given when the two leading follicles are 18mm in diameter.
• 35 to 37 hours after an HCG injection, oocyte or egg retrieval is performed under brief general anaesthesia.
• Laboratory isolation and identification of eggs.
• sperm collecting and laboratory processing. When there are no sperm in the semen (azoospermia), the sperm are taken directly from the testis using the PESA/MESA/FTNB/TESE or TESA procedures.
• Using the enzyme Hyloronetis, the eggs were dissected in a lab setting. putting eggs into tiny culture media droplets submerged in oil.
• Sperms are placed in tiny PVP droplets that are submerged in oil. Using a micro-injection needle with a 7 micron diameter to immobilise the sperm and aspirate it into the needle (tail first).
• using a holding pipette to hold the egg while injecting the immobilised sperm into the held egg these eggs are put into the incubator for two to five days.
• 2 to 5 days after fertilisation, embryos begin to develop.
• after two (four cell embryo), three (six-eight cell embryo), or five (blastocyst stage) days following egg removal, the transplantation of healthy embryos back into the womb.

Indications :

• men who suffer from severe sperm issues, such as low sperm counts (less than 5 million), extremely slow sperm movement, or a significant level of defective sperm.
• Male who have azozoospermia, in which there are no sperm in the semen. Azozoospermia may be of the obstructive kind, in which the testis produces sperms but the conduction pathway that transports the sperm to the semen is blocked. A non-obstructive azoospermia, in which the testis fails to generate sperm, is another possibility.
• The SPERM Retrieval Techniques of PESA/TESA/TESE can now be used to isolate sperms straight from the testis in both of these kinds of azoospermia, allowing ICSI to be conducted on.

Males with sperm anti-bodies

Men who have ejaculated dysfunction from a spinal cord disorder or injury, such as paraplegics or quadriplegics.

Patients who attempt IUI but are unsuccessful due to retrograde ejaculation (ejection of sperm into the bladder).

Patients in whom in vitro fertilisation has not resulted in pregnancy.

In our clinic, we also think that using ICSI on patients with a history of endometriosis or TB is a good idea because we think it results in higher fertilisation rates than traditional IVF (this is a personal experience not supported by international literature).

For all patients, including those with normal sperm counts, several units now advocate routine ICSI. As we feel that pregnancy should be achieved with the least amount of handling of the gametes outside the body, we do not support this procedure. We won’t perform ICSI if the sperm count is sufficient for IVF fertilisation. However, if a patient’s sperm count is in the grey area, we can choose to use IVF for half the eggs and ICSI for the other half.

Our success rates, which are similar to the best in the world for both azoospermia and non-azoospermia patients, are in the range of 30 to 40%.

Concept:

ICSI uses a different method of fertilisation than IVF. ICSI is a process where each egg is held and injected with a single live sperm, in contrast to IVF when one egg is combined with one lakh sperms, with fertilisation taking place on its own. The Micromanipulator, a device, is used to perform this micro-fertilization. There are 11 steps in the technique (anchor).

Procedure:

Controlled Ovarian stimulation with drugs (GnRH Analogues and Gonadotrophins) to produce many eggs.

Monitoring of follicles and egg development with the aid of vaginal sonography and serial estradiol hormone estimation. Administration of hCG injection, (Human Chorionic Gonadotrophins) when the two leading follicles are 18mm. in diameter. Oocyte or egg retrieval under short general anaesthesia, 35 to 37 hours after HCG injection.

Laboratory isolation and identification of eggs

sperm collecting and laboratory processing. When there are no sperm in the semen (azoospermia), the sperm are taken directly from the testis using the PESA/MESA/FTNB/TESE or TESA procedures.

the laboratory dissection of the eggs using the enzyme hyloronetis putting eggs into tiny culture media droplets submerged in oil.

Sperms are placed in tiny PVP droplets that are submerged in oil. Using a micro-injection needle with a 7 micron diameter to immobilise the sperm and aspirate it into the needle (tail first).

Using a holding pipette to hold the egg while injecting the immobilised sperm into the held egg these eggs are put into the incubator for two to five days. 2 to 5 days after fertilisation, embryos begin to develop.

after two days (four cell embryo), three days (six to eight cell embryo), or five days (blastocyst stage), good quality embryos are transferred back into the womb.

Indications :

• Men with serious sperm issues, such as low sperm counts (less than 5 million) extremely slow movement and a significant level of defective sperm. Babies and Us thinks that pregnancy should be achieved with the least amount of handling of the gametes outside the body, despite the fact that ISCI is performed on patients even with normal sperm counts. We might use IVF for half the eggs and ICSI for the other half if a patient has a sperm count that is borderline.
• Azolospermia is a condition in which males lack sperm in the semen. The azoospermia may be of the obstructive type, in which the testis produces sperms but they are unable to reach the semen due to a blockage in the conduction system. As an alternative, the azoospermia

• Men who have anti-sperm antibodies.
• Male who have ejaculated malfunction as a result of spinal chord damage or who are paralysed or quadriplegic.
• Patients who fail to permit conception due to retrograde ejaculation (ejaculation of the sperm into the urine bladder).
• Patients for whom in vitro fertilisation has not succeeded.
• ICSI is used at Babies and Us on individuals who have a history of endometriosis or TB because we feel it has higher fertilisation rates than traditional IVF (this is a personal experience not supported by international literature).