Intracytoplasmic sperm injection(2)

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2. 2 Intracytoplasmic sperm injection Presented by Mian Numan Mphil_AGB

3. Key words (ICSI) Intracytoplasmic sperm injection (IVF) in vitro fertilization 3

4. contents Introduction Who might need ICSI. How is ICSI performed/stages of ICSI. couple Counselling. Benefits of ICSI. Fertilization and pregnancy success rates with ICSI Potential problems with ICSI. Alternative treatment options to IVF with ICSI. References . 4

5. what is intracytoplasmic sperm injection (ICSI). Intracytoplasmic sperm injection is a micromanipulation technique used in the process of fertilization (IVF). It involves injecting a single sperm in to the centre of a mature oocyte under a microscope (i.e. injecting sperm through the egg’s shell so that the sperm does not need to penetrate the shell in order to fertilize the egg). 5

6. (ICSI) differs from conventional (IVF). Intracytoplasmic sperm injection (ICSI) differs from conventional in vitro fertilization (IVF) in that the embryologist selects a single sperm to be injected directly into an egg, instead of fertilization taking place in a dish where many sperm are placed near an egg.   6 (IVF) (ICSI)

7. Who might need intracytoplasmic sperm injection? Couples experiencing the following infertility issues may benefit from intracytoplasmic sperm injection: Low numbers of sperm produced or ejaculated. Sperm that are abnormal. Problems with antibodies against sperm. Testicular cancer. you are using frozen sperm in your treatment which is not of optimum quality 7

8. Low numbers of sperm produced or ejaculated this can be due to retrograde ejaculation or a blockage in the vas deferens, the tubes that carry sperm out of the testes. A complete absence of sperm in the ejaculate can be overcome if there is sperm production inside the testes. Sperm retrieval methods are used to extract sperm surgically to allow intracytoplasmic sperm injection to take place. 8

9. Sperm that are abnormal.  Sperm that are abnormal and cannot swim well. Obtaining plenty of sperm in normal ejaculate is straightforward and intracytoplasmic sperm injection can overcome the problems with getting these immobile sperm to meet up with the woman’s eggs. Problems with antibodies against sperm. these can be produced by the male partner in the fluid of the ejaculate, or by the female partner in cervical secretions. 9

10. Testicular cancer occur in younger men and treatment may mean that sperm production is affected. Sperm can be frozen before cancer treatment (which has a high success rate) and then the sperm can be used for icsi. 10

11. How is ICSI performed/stages of ICSI … couple Counselling Collection of sperm Collection of egg Cleaning and dilution Intracytoplasmic sperm injection Culturing of injected cells(16 to 20 hours) Selection or separating of fertilized eggs Transferring to fresh medium (2 to 5 days) (size 8 cells or more)  implantation or Cryopreservation. 11

12. couple Counselling All couples wishing to undergo (ICSI) should be counselled to the commencement of treatment. Counselling should address any concerns the couple may have also provide evidence based information regarding the likely outcomes and what to expect while undergoing intracytoplasmic sperm injection. Couples should also be aware that (ICSI) may fail, and be encouraged to discuss alternative options (e.g. use of donor sperm, adoption). In addition, couples undergoing (ICSI) should be aware of and discuss the increased risk of congenital abnormalities, particularly in male offspring. 12

13. Sperm collection fresh ejaculate but this is not possible in all male partners contributing sperm for intracytoplasmic sperm injection Men who cannot ejaculate because of nerve injury may be able to do so with electro-ejaculation. 13

14. course of hormone treatment /Egg collection. first given a course of hormone treatment to stimulate her ovaries to produce several eggs. Monitoring of woman These are monitored using ultrasound Collection of eggs once mature egg follicles have formed, the eggs are collected using a thin tube passed through the vagina. The eggs are then placed in special culture fluid in the laboratory 14

15. Sperm washing is a form of sperm preparation that is required is for IVF, because it removes chemicals from the semen, which may cause adverse reactions in the uterus. During the sperm washing process sperm is separated from the seminal fluid. This procedure enhances the fertilizing capacity of the sperm. Cleaning and dilution 15

16. Intracytoplasmic sperm injection The mature egg is held with a holding pipette. A very sharp and hollow needle is used to immobilize and pick up a single sperm. This needle is then inserted through the zona (shell of the egg) and in to the center (cytoplasm) of the egg. The sperm is injected in the cytoplasm and the needle is removed. The eggs are checked the next morning for evidence of normal fertilization. 16

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18. Benefits of intracytoplasmic sperm injection ICSI enables fertilization to happen when there are very few sperm available Before the development of intracytoplasmic sperm injection, male infertility related to abnormal semen count was considered largely untreatable. This assisted reproductive technique has therefore enabled many couples who would not previously have been able to conceive, or who would have been reliant on donor sperm, to conceive a biological child. 18

19. Fertilization and pregnancy success rates with ICSI Success is 35% in women aged 30 to 35, 20% at 35 to 40 and less than 10 % after 40. It is better to avail IVF before it is too late.  Blastocyst embryo transfer at the 5–6 day stage, generally has higher success rates than embryo transfer at the 2–3 day stage. depending on the age of the couple, hormone levels, disease (Diabetes mellitus, hypertension, etc.) and lifestyle (excess weight, stress, alcohol and nicotine use, etc.) 19

20. Fertilization and pregnancy success conti… IVF with ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician. 20

21. Fertilization and pregnancy success conti… In other words, the average egg quantity and quality tends to be better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs - as compared to cases with unexplained infertility. Some unexplained cases have reduced egg quantity and/or quality - which lowers the chances for a successful IVF outcome. 21

22. Rates of successful ICSI in vitro fertilization by season in a recent study 22 22

23. Potential problems with intracytoplasmic sperm injection. The vast majority of children that are born as a result of intracytoplasmic sperm injection are healthy but there is a risk that if the father produces abnormal sperm, this may be due to a genetic trait that is passed on to the child. It may be possible to test for known genetic diseases using  p re-implantation genetic screening (PGS)but if there is no obvious genetic abnormality, there is no test. 23

24. Alternative treatment options to IVF with ICSI. Intrauterine inseminations with the male partner sperm. This involves sperm processing in the lab, and then placement of the processed sperm through the cervix and up into the uterine cavity using a sterile catheter by using a sterile catheter. 24

25. References NCBI (PUBMED ) Advanced Fertility Center of Chicago Harley Street Fertility Clinic London, United Kingdom 25

26. Mian Numan kakakhel M.Phil research scholar NARC (national agriculture research center Islamabad) pakistan email : [email protected] Cell #00923149223397 26

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