About IVF and ICSI

What is IVF?

IVF is an acronym for in vitro fertilization (‘in vitro‘ meaning ‘in glass’).

Simply put IVF is adding a man’s sperm to his female partners eggs in the laboratory to produce embryos.

In vitro fertilization is an option for many couples who cannot conceive through conventional therapies. These embryos are put back into the female partner’s uterus (womb) after 3 to 5 days of being in the incubator, hopefully they will then grow into a baby. The reasons IVF is done include – poor sperm quality and/or quantity, obstructions between the egg and sperm, ovulation problems, and sperm-egg interaction problems.

These problems can prevent couples having a baby naturally, and IVF helps to solve this.

Specific conditions that might require IVF include:

  • Tubal blockage or failed tubal reversal
  • Endometriosis
  • Cervical factor
  • Pelvic adhesions
  • Male factor
  • Unexplained infertility/ failed conventional therapy

The first IVF baby was Louise Brown, born at 11:47 p.m. on July 25, 1978 at Oldham General Hospital, Oldham, England through a planned caesarean section. She weighed 5 pounds, 12 ounces (2.608 kg) at birth. Dr. Patrick Steptoe, a gynecologist at Oldham General Hospital, and Dr. Robert Edwards, a physiologist at Cambridge University, had been actively working on finding an alternative solution for conception since 1966.

What is ICSI?

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems.

A small amount of washed sperm is placed into thick viscous media containing poly vinyl pyrrolidone (PVP) in a dish. The PVP slows the sperm down so that they can be morphologically assessed. The most normal looking sperm are selected and then immobilized by squashing their tales with a glass injection needle. The sperm are sucked into the needle tail first ready to be injected.

The egg is then placed under a microscope and moved using micromanipulation devices (micromanipulators, microinjectors and micropipettes). A holding pipette stablizes the mature oocyte then from the opposite site a thin, hollow glass needle is pierced into the inner part of the oocyte. It is loaded with a single sperm that will be expelled into the oocyte

After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.

In natural fertilization sperm compete and when the first sperm enters the egg cell, the egg cell blocks the entry of any other sperm. Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without undergoing any specific testing.

Reasons for ICSI:

  • Sperm completely absent from the ejaculate (azoospermia)
  • Sperm present in low concentrations (oligospermia).
  • Poor sperm motility (asthenospermia)
  • Poor sperm morphology (teratospermia)
  • Sperm retrieved by surgical techniques (for example TESA, TESE)
  • Problems with sperm binding to and penetrating the egg
  • Antisperm antibodies
  • Previous failed or poor fertilization
  • Unexplained infertility
  • Frozen sperm limited in quantity
  • If preimplantation genetic diagnosis (PGD) is being used to screen embryos for a specific genetic disorder

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