| Intracytoplasmic
Sperm Injection (ICSI)
ICSI is a procedure used in conjunction with IVF to help couples with moderate to severe male factor infertility, unexplained
infertility, failed fertilization, and other conditions. ICSI involves
the injection of a single sperm directly into an egg after withdrawal
from the ovarian follicles in a stimulated IVF cycle. Before ICSI, the
only option for couples with moderate to severe male factor infertility
was to use donor sperm. While at the Jones Institute, Dr. Muasher participated
in the original research to develop the ICSI technique and establish its
clinical value.
If the male produces
enough viable sperm in his ejaculate, it is collected by masturbation.
ICSI also makes it possible for men with little or no sperm in their ejaculates
to father children. Procedures such as testicular sperm aspiration (TESA)
and microscopic epididymal  sperm aspiration (MESA) allow retrieval of
sperm directly from the reproductive tract. Sperm are extracted from the
testicles in TESA and from the epididymis (numerous small tubules within
the scrotum) in MESA.
The sperm are specially
washed and prepared for injection into the eggs. This is accomplished
using a microscopic pipette while the eggs are visualized and held in
place by an instrument known as a micromanipulator. This is a very delicate
procedure requiring dexterity and precision. Our embryologists,
Abeer Ibrahim and Leena Amr have extensive ICSI experience and they consistently
produce high fertilization rates. Normal fertilization is expected in
approximately 70% of the eggs that are injected and the pregnancy rates
are similar to those achieved with routine IVF and are dependent on female
age and other factors.
After the ICSI procedure,
the fertilized eggs (embryos) are placed in incubators where they remain
until ready for transfer.
As the name implies,
assisted hatching is a procedure that helps the embryo "hatch"
from its surrounding membrane. The embryo must break free of the zona
pellucida so that it can attach to the endometrium.
Once the embryo is
ready for transfer, a small hole is made in the membrane either chemically
using acidified Tyrode's solution or with a laser. Assisted hatching is
most often used in couples who fail repeated ART attempts, older women,
or when poor quality embryos are suspected.
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