Intracytoplasmic sperm injection (ICSI) fertility treatment

ICSI involves injecting a single sperm into a single mature egg. Standard IVF involves adding many sperm to a dish containing the eggs. The sperm and eggs are left for a period of time to allow sperm to penetrate the egg naturally. ICSI is recommended for couples with fertility challenges due to male factors or those where standard IVF has been unsuccessful.

An initial IVF cycle with ICSI is estimated to be $5428 out-of-pocket, excluding the initial consultation. Costs may differ by state. See here for more.

At City Fertility, an average of 70% of mature eggs will fertilise normally after ICSI. It is important to note that ICSI doesn’t guarantee fertilisation. There are several factors that influence the ability of an egg and/or sperm to create a normal embryo.

For the egg: As ICSI is more invasive and requires more handling of the oocyte than standard IVF, there is a small chance (less than 2%) that the egg may be damaged during the procedure, resulting in a non-viable egg, preventing if from fertilising.

For the child:

Thousands of children globally have been born as a result of ICSI. So far, there is no convincing evidence that the incidence of congenital disorders is higher when using ICSI or IVF compared with children conceived naturally to other parents of similar age and health.

The mother’s age at delivery, family history and the presence of pregnancy complications are the most important predictors of newborn health. However, a male child born as a result of ICSI may experience the same fertility challenges as his father if the cause is genetic..

As part of our ICSI  treatment procedure at City Fertility, we use a medium named Sperm Slow™ during sperm selection. It contains hyaluronan (HA), which binds sperm that are more likely to have normal DNA. By selecting the sperm that are bound to HA and using them for ICSI, the embryologists are using better-quality, more mature sperm. While this technique is standard practice, it may not be suitable for all patients.

Before ICSI can be carried out, mature eggs must be retrieved during a standard stimulated IVF cycle.

After the eggs are collected, the outer coating of cells is removed from each. Only then can we be sure the egg is mature enough to undergo ICSI.

You will be notified the following day as to how many eggs from your collection were mature and how many were inseminated.

The male partner’s semen sample is prepared in the lab to isolate healthy, moving sperm for the ICSI procedure.

Motile sperm is selected for injection based on their morphology (shape). This visual approach may not necessarily reflect their ability to fertilise an egg (oocyte). Sperm Slow™ provides a functional test based on the ability of sperm to bind to HA – hydrogel mimicking the natural binding of mature sperm to oocytes in the female.

A very fine special glass instrument (pipette) is used to hold the egg still. It is so small you can barely see the tip. A thinner, sharp, glass needle-like instrument selects and immobilises, then picks up a single sperm.

With great care and precision, the needle is inserted through the egg’s outer coating and into the egg itself. The immobilised sperm is then slowly injected into the egg and the needle carefully removed.

The injected eggs are placed in an incubator and checked the next morning for signs of fertilisation. After a further 24 hours, we can determine how many have divided and gone on to form embryos.

It is important to note that not all eggs will fertilise and not all fertilised eggs become embryos.

Conventional ICSI selects sperm based on appearance (morphology only). The basis for this is that sperm with normal appearance are less likely to contain damaged DNA. Physiological Intracytoplasmic Sperm Injection (PICSI) uses additional factors to select the sperm. At City Fertility, we use SpermSlow^TM to perform PICSI. Sperm that are bound by the medium are less likely to have damaged DNA, thus giving the embryologist extra assistance in selecting better quality sperm.

Sperm in vivo (in nature) encounters HA in the cervical mucus and in the cumulus matrix surrounding the egg. It is also found at the top of the sperm head. Penetration of the cervical mucus and cumulus matrix by the sperm in vivo is a critical element in successful fertilisation and subsequent embryo implantation (when the fertilised egg attaches to the lining of the uterus). HA is vital in this interaction.

Sperm Slow™ takes advantage of this naturally occurring encounter and allows the embryologist to select HA-bound sperm for injection. By selecting the sperm that is bound and using them for ICSI, the embryologists are preferentially using the better-quality, less DNA fragmented and more mature sperm.

Sperm bound to HA are likely to have less DNA damage and a normal chromosome complement. While there is usually no visible difference at the stage of eggs that fertilise, there is generally better day-3 to day-5 embryo development. Additionally, more blastocysts(day 5 to day 7 development) are available for vitrification (freezing), and significantly higher ongoing pregnancy rates have been shown for patients using ICSI with Sperm Slow™ compared with standard ICSI, which is why we use it as standard procedure in our labs.

The potential fertility improvement that this type of treatment may yield also depends on the woman’s age, diagnosis and the initial semen assessment, and should be discussed with your specialist.

Please note: Patients using testicular sperm (where most sperm are not progressively motile) and patients with less than 1 million motile sperm in the final sample preparation may be unable to use Sperm Slow™.