The document outlines the process of Intracytoplasmic Sperm Injection (ICSI) used to address male infertility issues such as low sperm counts and previous IVF failures. It details methods for sperm retrieval, including normal ejaculation, percutaneous aspiration, and testicular extraction, emphasizing the importance of fertilization rates and conditions requiring ICSI. Additionally, it notes the risks associated with the procedure, including multiple births, ectopic pregnancies, and genetic concerns.

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Specialized tools and inverted
microscopes
Pick up a sperm using a specialized
ICSI needle Advanced through the egg
membrane
The sperm is injected into the inner
part of the egg (the cytoplasm).
Then fertilization occurs in 75 - 85%
of eggs injected with sperm.

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Male infertility factors that includes low sperm counts, poor motility or movement of the sperm,
poor sperm quality, sperm that lack the ability to penetrate an egg or azoospermia.
Failure of fertilization in previous IVF attempts.
If the male partner underwent a vasectomy and sperm have been collected from the testicles or
epididymis.
If male partner has problems in erection or ejaculation.
It is used for couples with a small number of eggs at egg retrieval, to get a higher percentage of
eggs fertilized than when mixing eggs and sperms together in the IVF procedure.

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 Stimulation Of Ovaries
 Collection Of Eggs by hollow needle & ultrasound guidance.
 Sperm Picking by delicate needle.
 Transferred to the uterus 2 to 3 days after fertilization.
 Pregnancy test should be done 2 weeks after the embryo transfer.

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Methods of sperm retrieval for I.C.S.I
 If there were sperm in the semen, a sperm sample can be produced by
normal ejaculation into a cup on the same day of egg collection.
 If there is no sperm in the semen, the doctor can extract sperm from the
male partner under local or general anesthesia.
Percutaneous Epididymal Sperm Aspiration & I C S I (P.E.S.A , M.E.S.A)
It is only required if the husband has one of the following problems:
 Absence of the vas deferens (through which the sperm passes from the
epididymis to the seminal fluid ).
 Past Infections that result in obstruction.
 Cases who have had a vasectomy and surgical reversal failed.

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Testicular Sperm Aspiration & I.C.S.I (T.E.S.A, T.E.S.E)
 Obtaining sperm directly from the testes, either by
aspiration, using a needle or surgical extraction
 The sperm are then used to do the ICSI procedure as described
above.
This method is used in the following cases:
 Absence of sperms in the epididymis.
 Absent or obstructed epididymis.
 TESE might be done before the beginning of the treatment
cycle and the collected sperm are then frozen.

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 The risk of multiple births and ectopic pregnancy.
 The risk of congenital abnormalities.
 There is an increased risk of genetic problem carried by the sperm.
 ICSI is more expensive than IVF.

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