#IVF

What is ICSI (Intracytoplasmic Sperm Injection)?

ICSI is a modern and advanced reproductive technique in which a healthy sperm is injected directly into a woman's egg using a micro-needle to increase the chances of fertilization. This procedure is particularly used when the man's sperm is very weak, low in number, or immobile, and cannot reach the egg naturally.

Difference between IVF & ICSI

IVF and ICSI are both methods of assisted reproduction based on laboratory analyses; the fundamental difference lies in the fertilization method. In IVF, sperm acts through natural methods; in ICSI, a selected sperm is injected. ICSI is particularly useful in cases of male infertility and for attempts that are repeated, whereas IVF is widely useful when female factors are primary. Let us understand this in more detail.

The main difference between IVF and ICSI

1. IVF Fertilization process :

Eggs and thousands of sperm are mixed in a culture dish, and sperm are selected for fertilization.

2. Need for sperm in IVF :

Need for high quantity and quality of sperm.

3. Success rate in IVF :

Approximately 50% fertilization.

4. IVF Usage hints :

Female factors such as tubal disorders, ovulation disorders.

5. Potential risks :

Multiple pregnancies, OHSS, miscarriage, ectopic pregnancy.

The main difference between IVF and ICSI

Aspect

In-Vitro Fertilization (IVF)

Intracytoplasmic Sperm Injection (ICSI)

1. Fertilization process

Eggs and thousands of sperm are mixed in a culture dish, and sperm are selected for fertilization.

Only one viable sperm is selected and injected directly into the egg.

2. Need for sperm

Need for high quantity and quality of sperm.

Minimum (one) sperm is sufficient—especially useful for low numbers or quality.

3. Success rate

Approximately 50% fertilization.

50–80% fertilization, a better option when there is a sperm-related issue.

4. Usage hints

Female factors such as tubal disorders, ovulation disorders.

Male reasons (low sperm count, motility), freeze gametes, failure in the first IVF.

5. Potential risks

Multiple pregnancies, OHSS, miscarriage, ectopic pregnancy.

Damage to the egg, a slightly increased risk of birth defects.

Which to choose: IVF or ICSI?

1. If the male factor is the main issue, ICSI is more suitable: higher fertilization rate, lower drop-out rate.

2. If the main reason is associated with female problems - such as blocked fallopian tubes, issues with ovulation, or unexplained infertility - then IVF is the first option.

3. Often, the doctors start with IVF, and if fertilization does not occur, they integrate ICSI into the next procedure.

4. In the decision, the woman's age, the quality of the eggs, the financial situation, and the personal medical history are important.

Who Can Benefit from ICSI Treatment ?

ICSI is an advanced technique of assisted reproduction (ART) in which a sperm is injected directly into the cytoplasm of an egg. It is particularly useful for couples who have difficulties becoming pregnant due to male factors.

1. Male factor infertility

ICSI is extremely beneficial for men with a low sperm count, poor motility, or abnormal morphology.

For those with blocked sperm pathways, such as in cases of vasectomy, lack of stimulation, or retrograde ejaculation, conception is made possible through ICSI.

If azoospermia is detected in the sperm analysis and sperm has been surgically retrieved

2. Failure of fertilization in IVF

If fertilization does not occur during traditional IVF or the success rate of fertilization is very low, ICSI proves to be an extremely useful tool in the next attempt.

3. Cryopreserved eggs/sperm

If previously frozen eggs or sperm are used, the chances of fertilization by ICSI increase.

4. Pre-implantation Genetic Testing (PGT/PGD)

If it is necessary to perform genetic tests (PGT/PGD) before the implantation of the embryo, ICSI is the better option, as it ensures that only a pre-selected sperm is injected into each egg.

5. Female age or egg problem

In certain cases, women over 35 years old with a low number of eggs may be offered the ICSI option in IVF, although this is not effective in all cases.

Benefits of ICSI

In cases of male infertility, the fertilization rate improves: about 50 to 80% of the eggs can be successfully fertilized.

Even after a failure in the IVF cycle, there is another chance.

The likelihood of fertilization increases with provided or frozen gametes.

Suitable for PGT/PGD: the sperm are injected individually, allowing genetic testing to be performed.

Process Of ICSI Treatment

1. Initial consultation and examination

The medical and family history of the couple is examined.

In women: Hormone tests (FSH, LH, AMH), ovarian reserve, and the condition of the fallopian tubes are assessed using transvaginal ultrasound.

In men: A sperm analysis is performed; sometimes a surgical sperm retrieval like TESE/PESA may be necessary.

2. Ovarian Stimulation

Women receive hormone injections (FSH, LH, or GnRH agonists) over a period of 9 to 12 days to produce multiple eggs.

The growth of the follicles is monitored periodically through ultrasound and blood tests.

3. Trigger Injection

When the follicles reach about 18-20 mm, hCG or a trigger injection is administered.

The procedure for egg retrieval takes place 34-36 hours later.

4. Egg Retrieval

During the transvaginal ultrasound procedure, a fine needle is inserted through the vagina under light anesthesia to reach the ovaries and aspirate the eggs.

This procedure takes between 15 and 30 minutes.

5. Sperm Collection and Preparation

On the same day, the man's sperm is provided; if necessary, the sperm is extracted using TESE/PESA.

The high-quality sperm is selected and purified from the semen using methods such as swim-up, density gradient, or microfluidics (PICSI, IMSI).

6. ICSI Fertilization

In the IVF lab, the embryologist holds each egg with a micropipette. A selected healthy sperm is injected directly into the plasma of the egg with a second needle

This method is more controlled than traditional IVF and achieves a fertilization rate of 75 to 85%.

7. Embryo Maintenance and Selection

Fertilization is checked after 16-18 hours (mainly two pronuclei appear in healthy eggs).

The embryos are cultured for 3-5 days until they reach the blastocyst stage; after that, the best embryos are selected.

8. Embryo Transfer

The selected embryos are transferred into the uterus using a catheter guided by ultrasound.

This process takes about 5 to 10 minutes and is usually painless; some mild discomfort may occur.

9. Additional embryo preservation (Embryo Freezing)

If 1-2 embryos are not used, they are frozen using vitrification technology for future use.

10. Pregnancy Test and Follow-up

Pregnancy is confirmed about 12 to 14 days later by a blood test for β-hCG.

If the result is positive, a heartbeat can be seen in the ultrasound examination in the 5th to 6th week, and further monitoring is carried out under the guidance of a doctor.

Useful information

Typically, an ICSI cycle takes about 3 to 4 weeks to complete

ICSI is particularly suitable for couples who have issues with the male factor, possess cryopreserved gametes, or have experienced fertilization failure in a previous IVF cycle.

Risk Factors of ICSI Treatment

ICSI (intracytoplasmic sperm injection) is an advanced form of IVF technique that is applied when there is a problem with male infertility or when IVF has not been successful. Although many couples have become parents through ICSI treatment, there are also some important risk factors that should be understood.

1. Risk of miscarriage

The likelihood of a miscarriage after an ICSI conception may be slightly higher compared to IVF. The reasons for this could be the quality of the embryo and the age of the woman.

2. Slightly increased risk of birth defects

Some research has shown that children born through ICSI may have a slightly higher incidence of birth defects (such as heart defects, urological problems, etc.) compared to the general population. However, this risk is very low, and most children are healthy.

3. Genetic disorders

If the man has a genetic issue with his sperm, this may be passed on to the child through ICSI. Therefore, it is often recommended to consult a genetic counselor.

4. Multiple pregnancies (twins or more)

When more than one embryo is transferred during ICSI, the risk of multiple pregnancies, such as twins or triplets, increases. This can lead to problems such as premature births or low birth weight.

5. Risk of damage to eggs and sperm

During ICSI, the sperm is injected into the egg with a micro-needle. Sometimes, during this process, the eggs or sperm can be damaged, which can result in the possibility of fertilization failing.

6. Costly and mentally taxing procedure

ICSI is an expensive technique, and there is no guarantee of success. Ongoing and unsuccessful attempts can mentally exhaust couples, leading to problems such as stress, anxiety, and depression.

Conclusion:

ICSI is an effective fertility treatment, but it is very important to understand the risks before choosing it. Only choose this procedure after consulting a good fertility specialist. Timely medical examinations and appropriate care can significantly reduce these risks.