Sperm collection. If sperm cannot be collected by means of masturbation, they
are surgically removed from a
testicle through a small incision. This method of
sperm retrieval is done when there is a blockage that prevents sperm from being
ejaculated or when there is a problem with sperm development. To screen for
possible genetic problems that could affect offspring, experts recommend that
men with little or no sperm in their semen (not due to a blockage) have genetic
testing before they proceed with ICSI.1
By Gina Shaw
3 women, each trying to build a family, have been waiting on
some important — and nerve-racking — developments. Will Jody's latest fertility
treatment succeed? Will Carrie's labor go smoothly? Read about their latest
challenges and triumphs.
Ovulation and egg retrieval. To prepare for an
assisted reproductive procedure using your own eggs, you must get daily
injections and be closely monitored for 2 weeks before egg retrieval. At home,
you or your partner injects you with gonadotropin or
follicle-stimulating hormone (FSH) to stimulate your
ovaries to produce multiple eggs (superovulation). After the first week,
your doctor checks your bloodestrogen levels and uses
ultrasound to see whether eggs are maturing in the
follicles. During the second week, your dosage may
change based on test results and ultrasound. If follicles fully develop, you
are given a human chorionic gonadotropin (hCG) injection to stimulate the
follicles to mature. The mature eggs are collected 34 to 36 hours later using
laparoscopy or needle aspiration guided by ultrasound
through the abdomen to the ovaries.
Sperm injection and transfer. Under high-power magnification, a glass tool
(holding pipet) is used to hold an egg in place. A microscopic glass tube
containing sperm (injection pipet) is used to penetrate and deposit one sperm
into the egg. After culturing in the laboratory overnight, eggs are checked for
evidence of fertilization. After incubation, the eggs that have been
successfully fertilized (zygotes) or have had 3 to 5 days to further develop
(zygotes or blastocysts) are selected. Two to four are placed in the uterus
using a thin flexible tube (catheter) that is inserted through the cervix. The
remaining embryos may be frozen (cryopreserved) for future attempts.
What To Expect After Treatment
Overall, in vitro fertilization
(IVF)-related injections, monitoring, and procedures are emotionally and
physically demanding of the woman.
Superovulation with hormones requires regular blood
tests, daily injections (some are quite painful), and frequent monitoring by
These procedures are done on an outpatient basis and
require only a short recovery time. Your doctor may advise you to avoid
strenuous activities for the remainder of the day.
Why It Is Done
Intracytoplasmic sperm injection
(ICSI) is used to treat severe male infertility, as when little or no sperm are
ejaculated in the semen. Immature sperm collected from the testicles are
usually unable to move about and are more likely to fertilize an egg through
Some couples choose to try ICSI after repeat in vitro
fertilization has been unsuccessful. In the United States, about half of IVF
procedures are currently performed using ICSI technology.5
ICSI is also used for couples who are planning
to have genetic testing of the embryo to check for certain
genetic disorders. ICSI uses only one sperm for each
egg. So there is no chance the genetic test can be contaminated by other
How Well It Works
Used with in vitro fertilization and
eggs of good quality, ICSI often is a successful treatment for men with
impaired or no sperm in the ejaculate. ICSI (using sperm collected from the
testicles) produces an estimated 25% to 30% birth rate.2
ICSI does not improve the chances of conception
for men with good-quality sperm in the ejaculate.4
Risks related to ICSI are the same as for in
vitro fertilization, which increases the risks of ovarian hyperstimulation
syndrome and multiple pregnancy.
Superovulation with hormone treatment
severe ovarian hyperstimulation syndrome, occurring in
0.5% to 2% of all IVF treatment cycles.4 Your doctor
can minimize the risk of ovarian hyperstimulation syndrome by closely
monitoring your ovaries and hormone levels during
Approximately 35% of births in the United States that
result from assisted reproductive technologies such as IVF produce pregnancies
with twins or more.3Multiple pregnancies are high-risk for both a mother
and her fetuses.
There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as ICSI. Talk with your doctor about these possible risks.
Treatment success versus the risk of multiple pregnancy
In order for a woman over age 35 to maximize her chances of conceiving
with her own eggs and carrying a healthy pregnancy, she must have more embryos
transferred than do younger women. This practice, though, increases her risk of
conceiving multiple fetuses.
Because of the risks of multiple
pregnancy to the babies, experts recommend limiting the number of embryos transferred. Based on your age and your situation, your doctor will recommend a certain number of embryos to be transferred.
Women over 40 have a high rate of embryo loss when they use their own
eggs. As an alternative, older women can choose to use more viable donor
What To Think About
Doctors advise men who have little
or no sperm in their semen (not due to a blockage) to have genetic testing
before ICSI.1 Intracytoplasmic
sperm injection is an effective treatment for sperm-related infertility, but it
may carry genetic risks. Couples diagnosed with a chromosomal problem can seek
genetic counseling to learn their potential for having a child with birth
If you and your doctor are concerned about passing on a
genetic disorder to your child, talk to your doctor about preimplantation
genetic diagnosis. Some genetic disorders can be identified with specialized
testing before an embryo is transferred.
Frozen embryos are often less expensive and
less invasive for a woman, because superovulation and egg retrieval aren't
American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). Evaluation of the azoospermic
male. Fertility and Sterility, 90(Suppl 3):
American Society for Reproductive Medicine and Society for Male Reproduction and Urology (2008). The management of infertility due to obstructive azoospermia.
Fertility and Sterility, 90(Suppl 3):
Speroff L, Fritz MA (2005). Assisted reproductive
technologies. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1216-1274. Philadelphia: Lippincott Williams
Al-Inany H (2005). Female infertility, search date
April 2004. Online version of BMJ Clinical Evidence.
Also available online: http://www.clinicalevidence.com.
Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology (2008).
2006 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. Available online:
Primary Medical Reviewer
Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer
Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
March 19, 2010
WebMD Medical Reference from Healthwise
March 19, 2010
This information is not intended to replace the advice of a doctor.
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