According to a recent report published by WHO, about 1 in every 6 people worldwide experience infertility, which sums up to around 18 percent of the adult population. It is no secret that the number of couples struggling to get pregnant is higher than ever. But, clinical advancements such as Intracytoplasmic Sperm Injection (ICSI) and In Vitro Fertilization (IVF) have also made it easier than ever for such infertile couples to experience parenthood.
In this article, we will delve into the details of ICSI and IVF, highlighting their process, differences, benefits and considerations.
Understanding ICSI and IVF
Both the techniques are revolutionary advancements in the field of reproductive medicine, called Assisted Reproductive Technologies (ARTs). These techniques intend to escalate the chances of pregnancy by assisting the fertilization and implantation process.
But how?
Intracytoplasmic Sperm Injection (ICSI)
Primarily used as an add-on procedure during the IVF process, it is a specialized technique which involves fertilizing a mature egg collected during egg retrieval by a single sperm through direct injection.
Who needs ICSI?
The technique is primarily used for couples experiencing difficulty in conceiving due to male fertility issues. A couple is an ideal candidate for the treatment if the male partner has one or more of the following fertility problems:
- Low sperm count
- Poor sperm motility
- Abnormal sperm morphology
- Retrograde ejaculation
- Azoospermia
- Any blockages in the reproductive organ
How is it done?
The ICSI treatment takes place in conjunction with IVF and what happens before, during and after the procedure is as follows:
What happens before ICSI?
Before starting with the procedure, the fertility doctor has to collect mature eggs from the female partner, and sperm from the male partner. In case of frozen eggs or cryopreserved sperm, the procedure is tailored appropriately. Otherwise, the following procedures take place:
- Ovulation induction: To be able to collect multiple mature eggs for fertilization, fertility doctors administer certain fertility medicines for 9 to 14 days, starting from the day 2 to 4 of the menstrual cycle. These medicines include follicle-stimulating hormone (FSH) and luteinizing hormone (LH). They will cause ovaries to develop multiple follicles that carry the eggs at once.
- Egg retrieval: Once the ovarian follicles are mature and ready to release the eggs, a final shot of human chorionic gonadotropin (hCG) is administered to finish the final stage of egg maturation. Then, right before the ovulation takes place, a tiny needle connected to a suction device and guided by an ultrasound device is inserted into the ovaries through the vaginal wall, to detect and retrieve the developed eggs.
- Sperm collection: After egg retrieval, the male partner is asked to ejaculate in a sterile container. If the man cannot ejaculate due to retrograde ejaculation or any blockages, testicular sperm aspiration (TESA) is used in which a needle directly inserted into the testicles and sperm is collected. The male partner can also be instructed to refrain from sex or masturbation for a few days prior to the procedure. Right after collection, a thorough semen analysis is done to assess semen quality, count, motility and morphology. The sperm is then washed, concentrated and the healthiest ones are set aside for injecting.
What happens during ICSI?
Once the fertility doctor has prepared for the procedure, he or she:
- Places the mature egg on a lab dish.
- Uses a thin needle to pick up a single sperm cell.
- Inserts the needle to approach the cytoplasm of the egg.
- And, finally injects the cell into the cytoplasm and removes the needle from the egg.
What happens after ICSI?
Once the procedure has taken place, the IVF process continues further. The fertilized egg is kept in an incubating device (a clinical tool that mimics the artificial atmosphere of a woman’s womb) for next 5 days, until the egg makes it from the cleavage stage to blastocyst stage. Once the eggs have developed into blastocysts embryos, the most robust ones are selected for embryo transfer, and implanted around the uterine lining. After 14 days, a hCG pregnancy blood test is performed to confirm the pregnancy.
In Vitro Fertilization (IVF)
It is one of the assisted reproductive technologies (ARTs) intended to primarily treat infertility caused by female reproductive issues. IVF treatment helps infertile couples who struggle to conceive, conceive with by performing the fertilization process outside the woman’s body, in a laboratory.
Who needs IVF?
An ideal candidate for the treatment is a woman with:
- Blocked, damaged or abnormal fallopian tubes
- Endometriosis
- Polycystic ovary syndrome (PCOS)
- Primary ovarian insufficiency (POI)
- Irregular ovulation
- Polyps or fibroids
How is it done?
Except for injecting a single live sperm cell directly into a cytoplasm egg, conventional IVF and ICSI are performed likewise.
Difference between IVF and ICSI
Both the procedures can be compared on the basis of the following:
Fertilization process
In ICSI, a single live sperm is manually selected and injected into each mature egg. On the other hand, in IVF, the fertilization takes place in a more natural way, by introducing multiple sperm with eggs.
Success rate
ICSI has a higher rate of successful pregnancy if male-factor infertility is concerned. On the other hand, the success rate of IVF depends on a woman’s age, overall health, and underlying cause and severity of infertility.
Cost
Though the cost may vary depending on several factors, due to its high complexity, ICSI is comparatively more expensive than IVF.
Suitability
For ICSI, an ideal candidate who could benefit from the treatment is primarily a male with low sperm count, poor sperm motility, abnormal sperm morphology, ejaculation related reproductive problems. On the other hand, for IVF, an ideal candidate would be a woman with low ovarian reserve, reproductive abnormalities, or other health conditions that hinders fertility.
Risks
Both the procedures have a slight risk of the following:
Risk of Fertilization Failure
Risk of fertilization failure is higher in IVF, because poor quality sperm may fail to penetrate the egg and result in failure. But, when a manually selected sperm is injected into the egg directly, it minimizes the risk of fertilization failure.
Risk of Multiple Pregnancies
ICSI has a slightly lower risk of ending up in multiple pregnancies because a single live sperm is injected into each egg. However, IVF poses a higher risk because of multiple embryos being transferred.
The bottom line
The field of reproductive medicine has advanced a lot and fertility treatments like ICSI and IVF have helped countless infertile couples to start their family. While ICSI is specifically tailored to address male factor infertility problems, IVF offers a broader scope for addressing various infertility problems for both men and women. The choice between both the fertility treatments would mostly rely on the diagnosis and recommendation of the fertility specialist, while it is always great to have a basic understanding of their processes, benefits, and differences.
