This document provides an overview of intracytoplasmic sperm injection (ICSI). ICSI involves injecting a single sperm directly into a mature egg under a microscope, which differs from conventional in vitro fertilization where fertilization occurs outside the body. ICSI may be recommended for couples experiencing issues like low sperm counts, abnormal sperm, or problems with antibodies. The process involves sperm and egg retrieval followed by cleaning and injecting a sperm into an egg's cytoplasm. Success rates vary depending on patient factors, though ICSI enables fertilization when few sperm are available. Potential risks include genetic issues being passed to offspring if the father's sperm is abnormal.

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3. Key words
• (ICSI) Intracytoplasmic sperm injection
• (IVF) in vitro fertilization
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4. contents
Introduction
Who might need ICSI.
How is ICSI performed/stages of ICSI.
couple Counselling.
Benefits of ICSI.
Fertilization and pregnancy success rates with ICSI
Potential problems with ICSI.
Alternative treatment options to IVF with ICSI.
References .
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5. what is intracytoplasmic sperm injection (ICSI).
Intracytoplasmic sperm injection is a micromanipulation
technique used in the process of fertilization (IVF). It
involves injecting a single sperm in to the centre of a
mature oocyte under a microscope (i.e. injecting sperm
through the egg’s shell so that the sperm does not need
to penetrate the shell in order to fertilize the egg).
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6. (ICSI) differs from conventional (IVF).
Intracytoplasmic sperm injection (ICSI)
differs from conventional in vitro
fertilization (IVF) in that the embryologist
selects a single sperm to be injected
directly into an egg, instead of
fertilization taking place in a dish where
many sperm are placed near an egg.
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(IVF)
(ICSI)

7. Who might need intracytoplasmic sperm injection?
• Couples experiencing the following infertility issues
may benefit from intracytoplasmic sperm injection:
I. Low numbers of sperm produced or ejaculated.
II. Sperm that are abnormal.
III. Problems with antibodies against sperm.
IV. Testicular cancer.
V. you are using frozen sperm in your treatment which is
not of optimum quality
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8. Low numbers of sperm produced or ejaculated
o this can be due to retrograde ejaculation or a
blockage in the vas deferens, the tubes that carry
sperm out of the testes. A complete absence of sperm
in the ejaculate can be overcome if there is sperm
production inside the testes. Sperm retrieval
methods are used to extract sperm surgically to allow
intracytoplasmic sperm injection to take place.
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9. Sperm that are abnormal.
o Sperm that are abnormal and cannot swim well. Obtaining
plenty of sperm in normal ejaculate is straightforward and
intracytoplasmic sperm injection can overcome the
problems with getting these immobile sperm to meet up
with the woman’s eggs.
Problems with antibodies against sperm.
o these can be produced by the male partner in the fluid of
the ejaculate, or by the female partner in cervical secretions.
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10. Testicular cancer
occur in younger men and treatment may mean
that sperm production is affected. Sperm can
be frozen before cancer treatment (which has
a high success rate) and then the sperm can
be used for icsi.
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11. How is ICSI performed/stages of ICSI …
I. couple Counselling
II. Collection of sperm
III. Collection of egg
IV. Cleaning and dilution
V. Intracytoplasmic sperm injection
VI. Culturing of injected cells(16 to 20 hours)
VII. Selection or separating of fertilized eggs
VIII.Transferring to fresh medium (2 to 5 days)
IX. (size 8 cells or more)
X. implantation or Cryopreservation.
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12. couple Counselling
o All couples wishing to undergo (ICSI) should be counselled to the
commencement of treatment. Counselling should address any concerns the
couple may have also provide evidence based information regarding the
likely outcomes and what to expect while undergoing intracytoplasmic
sperm injection.
o Couples should also be aware that (ICSI) may fail, and be encouraged to
discuss alternative options (e.g. use of donor sperm, adoption). In addition,
couples undergoing (ICSI) should be aware of and discuss the increased risk
of congenital abnormalities, particularly in male offspring.
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13. Sperm collection
o fresh ejaculate but this is not possible in all male
partners contributing sperm for intracytoplasmic
sperm injection
o Men who cannot ejaculate because of nerve
injury may be able to do so with electro-
ejaculation.
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14. course of hormone treatment /Egg collection.
o first given a course of hormone treatment to stimulate
her ovaries to produce several eggs.
o Monitoring of woman
o These are monitored using ultrasound
Collection of eggs
once mature egg follicles have formed, the eggs are
collected using a thin tube passed through the vagina.
The eggs are then placed in special culture fluid in the
laboratory
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15. Sperm washing is a form of sperm preparation
that is required is for IVF, because it removes
chemicals from the semen, which may cause
adverse reactions in the uterus. During the
sperm washing process sperm is separated
from the seminal fluid. This procedure
enhances the fertilizing capacity of the
sperm.
Cleaning and dilution
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16. Intracytoplasmic sperm injection
o The mature egg is held with a holding pipette.
o A very sharp and hollow needle is used to immobilize and pick
up a single sperm.
o This needle is then inserted through the zona (shell of the
egg) and in to the center (cytoplasm) of the egg.
o The sperm is injected in the cytoplasm and the needle is
removed.
o The eggs are checked the next morning for evidence of normal
fertilization.
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18. Benefits of intracytoplasmic sperm injection
o ICSI enables fertilization to happen when there are very few
sperm available
o Before the development of intracytoplasmic sperm injection,
male infertility related to abnormal semen count was
considered largely untreatable. This assisted reproductive
technique has therefore enabled many couples who would not
previously have been able to conceive, or who would have
been reliant on donor sperm, to conceive a biological child.
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19. Fertilization and pregnancy success rates with ICSI
o Success is 35% in women aged 30 to 35, 20% at 35 to 40
and less than 10 % after 40. It is better to avail IVF before
it is too late.
o Blastocyst embryo transfer at the 5–6 day stage,
generally has higher success rates than embryo transfer
at the 2–3 day stage.
o depending on the age of the couple, hormone levels,
disease (Diabetes mellitus, hypertension, etc.) and
lifestyle (excess weight, stress, alcohol and nicotine use,
etc.)
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20. Fertilization and pregnancy success conti…
• IVF with ICSI success rates vary according to the
specifics of the individual case, the ICSI technique
used, the skill of the individual performing the
procedure, the overall quality of the laboratory, the
quality of the eggs, and the embryo transfer skills of
the infertility specialist physician.
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21. Fertilization and pregnancy success conti…
• In other words, the average egg quantity and quality
tends to be better in ICSI cases (male factor cases)
because it is less likely that there is a problem with the
eggs - as compared to cases with unexplained infertility.
Some unexplained cases have reduced egg quantity
and/or quality - which lowers the chances for a
successful IVF outcome.
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22. Rates of successful ICSI in vitro fertilization by
season in a recent study
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23. Potential problems with intracytoplasmic sperm
injection.
• The vast majority of children that are born as a result of
intracytoplasmic sperm injection are healthy but there is a
risk that if the father produces abnormal sperm, this may
be due to a genetic trait that is passed on to the child. It
may be possible to test for known genetic diseases
using pre-implantation genetic screening (PGS)but if there
is no obvious genetic abnormality, there is no test.
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24. Alternative treatment options to IVF with ICSI.
Intrauterine inseminations with the male
partner sperm. This involves sperm
processing in the lab, and then placement
of the processed sperm through the cervix
and up into the uterine cavity using a sterile
catheter by using a sterile catheter.
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25. References
• NCBI (PUBMED )
• Advanced Fertility Center of Chicago
• Harley Street Fertility Clinic
London, United Kingdom
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26. Mian Numan kakakhel
M.Phil research scholar NARC (national
agriculture research center Islamabad)
pakistan
email : numanbiotech@yahoo.com
Cell #00923149223397
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