What is IVF with ICSI?

What is IVF? In Vitro Fertilization (IVF) is the most common procedure in Assisted Reproductive Technology. IVF treatment cycles can be used in conjunction with a woman’s natural menstrual cycle, with induced ovulation as a solution to female infertility problems or as part of a surrogacy process using donor eggs and sperm donation.

In vitro fertilization means fertilization outside of the womb. Eggs are collected following ovarian stimulation and fertilized with collected sperm in a laboratory. Resulting embryos are implanted into the uterus using a catheter for embryo transfer.

Fertility clinics often use intracytoplasmic sperm injection (ICSI) to successfully fertilize eggs during in vitro fertilization treatment. ICSI removes any element of chance from the fertilization process by injecting sperm into the center of the egg. As IVF with ICSI requires only one healthy sperm to fertilize ova, fertility doctors recommend ICSI to couples where male factor infertility is a problem.

A Good Candidate for IVF with ICSI

Couples where male factor infertility is a problem are good candidates for IVF with ICSI treatment.

IVF with ICSI Procedure

There are three treatment stages to IVF with ICSI treatment: Egg and sperm collection, fertilization and embryo implantation.

Egg and sperm collection: Prior to starting treatment, a woman will be prescribed fertility drugs to induce ovulation and stimulate the ovaries to increase egg production. The fertility clinic will monitor hormone levels and perform regular vaginal ultrasounds to ensure the eggs are maturing. Thirty-six hours before egg collection, a hormone injection is given to ensure the eggs are mature and ready for fertilization. Sperm is collected at the same time as the woman’s eggs.

If sperm retrieval is problematic, fertility specialists can use various methods to collect sperm. Retrieved sperm is prepared for fertilization. Sperm is separated from semen, washed and spun before individual healthy sperm are selected. Once the eggs are ready for collection they are removed individually from the ovaries using a thin needle. A suction device attached to the needle and removes individual follicles with little discomfort to the patient.

Fertilization: The traditional fertilization process stage of IVF treatment involves the egg being placed with sperm in laboratory dishes. Fertility clinics commonly now use intra cytoplasmic sperm injection (ICSI) to improve the success rates of fertilization. ICSI involves the sperm being injected into the center (cytoplasm) of the egg. This process prevents sperm failing to fertilize the egg due to a hard external membrane of the ova.

Embryo implantation: Embryos can be transferred into the uterus between days 1 and 5. Embryo transfer is commonly performed on day 5 after fertilization during the blastocyst stage of cell development. Transferring embryos on day 5 replicates the most natural implantation process as the embryo has matured and the risk of cells dividing and multiple pregnancies is decreased.

IVF success rates vary depending on many factors and the rate of successful pregnancies varies between fertility clinics. The average success rate of IVF treatment is 15-20% per cycle.

Recovery from IVF with ICSI

IVF patients are advised to rest for the remainder of the day following the embryo transfer to ensure successful embryo implantation. Strenuous activities should be avoided for 3 days to reduce the risk of implantation failure.

Length of stay in country: 21-25 days, 14 if the patient begins treatment with fertility drugs in the home country.

Causes of Infertility

Infertility can be caused by a variety of reasons. There may be physical issues with the reproductive organs, hormonal imbalances, chromosomal or general genetic defects. Occasionally, certain lifestyle choices or diseases may inhibit a person’s ability to conceive. Infertility testing can help couples or intended parents discover these issues and begin the appropriate infertility treatment.

Causes of Female Infertility

Age: A woman becomes less fertile from the age of 30 and significantly more after the age of 35. When a woman enters menopause, the body stops releasing vital hormones that would normally allow her to become pregnant. This is an indication that her fertile phase has come to an end.

Hormonal Complications: Some women are infertile because they have a hormonal imbalance. This leads to irregular ovulation, anovulation and ultimately infertility. FSH (follicle stimulating hormone) is an important hormone that stimulates the growth and release of unfertilized eggs during the menstrual cycle.

Polycystic Ovarian Syndrome (PCOS): PCOS is an ovarian disorder where a woman has non-cancerous cysts on her ovaries. These cysts prevent normal hormone production of the ovaries thus leading to irregular ovulation.

Premature Ovarian Failure (POF): POF is when your ovaries stop functioning normally before the age of 40. They might not be producing enough estrogen or releasing eggs regularly. One of the most common signs of POF is irregular periods.

Malfunctions of the hypothalamus or pituitary gland can also lead to hormonal imbalances.

Abnormal Uterus: If a woman has a physical issue (genetic defect, abnormal growths such as fibroids) with her uterus it may lead to infertility. Endometriosis is a common condition that occurs in 5-10% of women and is characterized by a build-up of tissue in the lining of the uterus. An abnormal uterus can lead to repeated miscarriages.

Poorly Functioning Fallopian Tubes: If one or both of the fallopian tubes are blocked, the egg that a woman releases will not be able to reach the uterus or the sperm to become fertilized. This causes infertility in 40% of infertile women.

Other causes such as infection, abdominal diseases, previous surgeries, congenital defects and previous ectopic pregnancies can also lead to poorly functioning fallopian tubes.

Other Female Infertility Factors (including physical factors and lifestyle factors

· Semen allergy (an allergic reaction leads to antibodies killing sperm cells)

· Scarred ovaries (may lead to failed ovulation)

· Follicle problems (the egg stays inside the ovary and proper ovulation doesn’t take place)

· Abnormal female cervical mucus (normally a result of a hormonal imbalance)

· Significant weight loss or weight gain (can cause temporary infertility)

· Smoking, alcohol and drug use (all lead to fertility complications)

· Exposure to certain chemicals and substances (lead, radiation, ethylene oxide, Dibromochloropropane - DBCP)

Causes of Male Infertility

It takes one single sperm to be healthy and motile to travel to the uterus and penetrate the outer layers of a female egg. The male partner needs to have a relatively high sperm count to increase the chances of fertilization. The following issues may be related to sperm cells leading to infertility.

Oligospermia: One of the most common causes of male infertility is oligospermia, or low sperm count. Low sperm count can be a temporary or long term issue where the concentrations of sperm in semen are lower than normal. Overheating of the testicles, smoking, or drug use is a major cause. A standard sperm count is 20 million or more sperm per milliliter of semen.

Hypospermia and Hyperspermia: Hypospermia is due to a man’s low ejaculation count. Hyperspermia is related to a man’s high ejaculation count. Both can lead to infertility resultant of an imbalance; not enough sperm coming into contact with the female egg and too much can dilute the sperm concentration.

Aspermia and Azoospermia: Aspermia defines a complete lack of semen. Azoospermia is the absence of sperm cells in the semen itself.

Teratospermia: Abnormal sperm shape or structure can negatively affect the ability of sperm cells to travel and penetrate the egg. Normal sperm mobility is when two thirds of the sperm reach the egg. Teratospermia is the term used to describe an increase in sperm cells with abnormal morphology.

Other Male Infertility Factors

· Various day to day activities can have an adverse effect on sperm: tight underwear, saunas, certain medications and particular foods and drinks. Environmental toxins and radiation can also affect sperm

· Testicular

· Pre-testicular Factors – conditions relating to poor general health and lack of testes and hormonal support such as hypogonadism, drugs, alcohol and smoking.

· Testicular Factors – conditions where testes produce low and/or poor quality semen despite good support such as age, genetic defects and testicular cancer.

· Post-testicular Factors – conditions that physically affect the male reproductive system after regular sperm production such as impotence, problems ejaculation and vas deferens obstruction.

Cost of IVF with ICSI

In the United States, IVF with ICSI generally costs around $15,000, including agency and donor fees. Medications cost approximately $2,000 – $4,000 per cycle and usually average out to approximately $3,000 per treatment for fertility drugs.

In the UK the costs of IVF with ICSI is somewhat less, around 4,000GBP with additional costs for medications.