ICSI - Intra Cytoplasmic Sperm Injection
As in IVF, ICSI involves stimulating the maturation of several follicles in the woman, collecting the oocytes (eggs) via transvaginal aspiration, and then placing them in a culture medium.
However, contrary to classic IVF, a single sperm (from an ejaculation or from a sample taken from a testicle or the epididymis) is then directly injected into the cytoplasm of the oocyte.
After the embryos have been cultured for 2 to 5 days, a limited number of embryos are returned to the uterus, in accordance with legal provisions.
ICSI may be indicated for a very low sperm count (oligoasthenoteratozoospermia, and in cases of unexplained infertility).
What are the risks?
ICSI carries the same risks as IVF:
- In around 5% of cases, ovarian hyperstimulation can manifest itself through abdomen bloating (which fills with fluid). In rare cases, this can require a hospitalisation of a few days, with an intra-vaginal puncture to drain the fluid, and an intravenous drip to restore the hydromineral balance.
- In fewer than 2/1000 cases of oocytes retrieval, it can reawaken a previous infection of the tubes, requiring antibiotics and a hospitalisation of several days.
- In exceptional cases (1/1000) it can cause delayed bleeding where several follicles have been retrieved. Sometimes this may require a laparoscopy to remove the blood.
The highest risk used to be twin pregnancies (20% of pregnancies until 2003) and triplet pregnancies (2%).
With the current facilities available (transfer of a single embryo in young women), these risks have reduced to approximately 10% and 0.2% respectively, which is more or less equal to the risk of spontaneous multiple pregnancy in cases where MAR techniques have not been used.