In the case of the male factor infertility, standard insemination techniques may not be successful. In cases where sperm counts are very low or where fertilization has failed to occur with a prior IVF attempt, special egg insemination techniques may be used to help the sperm fertilize the eggs. Intracytoplasmic sperm injection (ICSI) is the most common specialized insemination technique.
The use of ICSI represents a major advance in reproductive medicine. From the patient's perspective, the process is similar to a regular IVF cycle, while the difference is in the laboratory handling of the sperm and eggs. The scientist takes a single sperm and, using sophisticated instrumentation, places the sperm directly into the center of the egg. In many cases, ICSI offers couples the hope of conceiving a child without the use of donated sperm. ICSI is not for everyone, however. Your physician will determine if ICSI is appropriate for you.
Testing For: Unfortunately, there is no good test performed to determine that a sperm will function normally other than IVF. Most programs will use a standard semen analysis to determine the number, motility and morphology of sperm found in the ejaculate. Other tests, such as the sperm penetration assay and the hemizona assay have also found some correlation with sperm fertilization capability, however, they are not foolproof. At RMA we use the standard semen analysis along with strict morphology (Kruger) and 24 hour survivability to determine whether or not ICSI is required. In general, we recommend ICSI for those having the following conditions: low count, low motility, low percentage of normal forms, vasectomy reversal, prior ICSI, presence of antisperm antibodies, prior low percentage fertilization during IVF or sperm obtained from either a TESA or MESA. On the day of the retrieval, your partner's sample is evaluated and it may be deemed necessary to proceed with ICSI considering that sperm samples can vary a great deal from day to day.
Risk Of: Thousands of infants have been born all over the world with the help of ICSI and the percentage of minor and major birth defects are the same as those in the general population. However, there is new data to indicate that men with severe sperm problems may pass along the same problem to their sons. For most men requiring ICSI, this is not an issue.
Success Rates: Surprisingly, pregnancy rates for those couples requiring ICSI tend to be among the highest due to the fact that partners of these men tend to be younger. The age of the female partner is by far the most important factor in predicting a couple's chance of success with ICSI. A few men with severe male factor due to maturational arrest of sperm development will have lower pregnancy rates.