1. What is ICSI?

IVF is Intra Cytoplasmic Sperm Injection. Fertilization is meeting of the egg and sperm to form the embryo. When this is done outside the body, by injecting a selected sperm into the egg, in couples who fail to conceive the natural way, it is called Intracytoplasmic sperm injection.

2. For whom is it recommended?

ICSI is recommended in patients with

Bilateral tubal block

Decreased egg number

Grade 3 endometriosis

Severe male factor (very less count or sperm motility)

Zero sperm count opting for testicular sperm retrieval

Repeated IUI failures

Recurrent abortions opting for Pre Implantation Genetic Testing

Unexplained infertility

Donor oocyte programme


3. How is it done?

Day 2 wife undergoes scan and Hormone tests

Injections given for all the follicles in her ovary to grow for around 10 days on an average (controlled ovarian stimulation)

Trigger injection is given for final maturation of eggs when almost all follicles are around 18 mm

Egg pick up is done around 35 hours after trigger

IVF/ICSI is done and eggs are fertilized in the lab

Embryo growth is assessed and transferred or frozen on day 3 or day 5 post egg pick up

Pregnancy test is done 13/15 (in day5/day3 transfer respectively) days after transfer

In case embryos are frozen, in the next cycle, lining of the uterus is prepared and embryos are thawed and transferred.

4. Is it painful?

As compared to previously used drugs, the currently available injections are less painful. Egg pick up is done under anaesthesia and pain is not felt by the patient. Embryo transfer requires no anaesthesia and a transfer done with minimal manipulation and absolutely no pain is most fruitful.

5. What are the chances of pregnancy with ICSI?

The success rate of ICSI depends on the couples age and cause for subfertility.

6. What is the difference between IVF and ICSI?

IVF involves incubating each egg we retrieve with few sperms and allowing a sperm to get naturally selected to fertilize the egg.

ICSI is Intracytoplasmic Sperm Injection wherein the best sperm is selected from the sample and is injected into the egg retrieved.

They are different ways of getting the egg fertilized and which process is chosen over the other is individualized by the clinician for each couple

7. Are there any side effects associated with ICSI?

Presently used medications and the process of ICSI is extremely safe with no/minimal side effects

8. Is there a chance of twin/multiple pregnancy with ICSI?

In the era of elective single embryo transfer, the chances of twin/multiple pregnancy is nil. But of course, if more than 1 embryo is transferred then the chances of multiple pregnancy obviously increases

9. Is bed rest recommended after ICSI?

Bed rest is not recommended after ICSI.

10. What precautions need to be taken after embryo transfer?

Healthy, home cooked, protein and fibre rich food

Small, frequent meals, adequate amount of water

Stress free lifestyle, meditation can be practised

No bed rest

Intercourse need not be restricted

Travelling long distance may be avoided

Taking the stairs may be allowed

Positive attitude is most important

11. What are the reasons for failure of ICSI?

A good embryo and a receptive endometrium are the key to a successful IVF cycle

Failure at any point, the following should be considered:

Age of the couple

Number of eggs, morphology of the eggs

Sperm parameters

Number of embryos formed and the grade of embryos

Endometrial thickness and vascularity

Transfer technique

Despite everything being good, if a cycle fails, patience and persistence for a second attempt definitely helps

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