65,772 fresh IVF or ICSI cycles were performed in Germany in 2016. In 9 of 10 treatments came it to a transfer and in 33% to a pregnancy. We know the result of 90% of all pregnancies. The probability of childbirth is 22.5%. According the statistic 78.4% singles, 21.1% twins and 0.5% triplets were born.
While the pregnancy rate in women under 30 years is over 40% per embryo transfer, the probability of pregnancy continuously decreases from the age of 34.
Patients aged 43 years and older only have 15% chance of pregnancy. At the same time, the frequency of miscarriage increases. In the age over 43 years chance to have a baby is below 8%. The age-related success of fertility treatments should always be taken into account. Age plays a particularly important role in deciding when effective fertility treatment should be started.
While patients up to the age of 35 can wait to start treatment, effective therapies should be considered earlier if they are 36 or older.
ICSI (Intracytoplasmic Sperm Injection) is the most widely used method of artificial insemination. In principle, only a single fertile sperm and egg are sufficient for this method. Here's how ICSI treatment works and why fertilization works in most cases.
What is the ICSI?
The abbreviation ICSI stands for "Intracytoplasmic Sperm Injection". This means that a single sperm is injected directly into the cell interior (cytoplasm) of the previously extracted egg cell with special pipette. The procedure repeats the natural penetration of sperm into the egg. However, the entire process happens outside the body (extracorporeal) and is controlled under the microscope.
How does ICSI work?
Before the ICSI, hormonal stimulation of the ovaries (ovarian stimulation) is necessary. For this purpose, different methods exist with different hormone preparations.
Ovulation and egg retrieval
If enough cells are present after ovarian stimulation, ovulation is triggered hormonally (hormone injection with human chorionic gonadotropin, HCG). About two days later, the puncture of the ovaries occurs. For this, the oocytes in the follicles are removed with a thin needle under ultrasound control and under light anesthesia through vagina.
On the day of egg retrieval fresh or prepared, frozen sperm must be available - for example, from a sperm donation. Based on appearance, shape and flexibility, the reproductive specialist selects a suitable sperm cell for the ICSI.
A relatively new variant for the selection of suitable sperm cells is via the binding ability of the sperm to the enzyme hyaluronidase. In this physiological variant of ICSI, short PICSI, should be only mature and genetically immaculate sperm identified. Only in the second step, the morphological criteria are considered in the decision. This selection method is intended to further improvement of ISCI success rate.
In the laboratory, the sperm cell is injected via a pipette directly into the cytoplasm of the oocyte. After this microinjection, the fertilized egg is putted in the incubator for two to four days. This shows whether the ICSI was successful. As the cell evolves, there is nothing to stop ISCI transferring the embryo to the uterus. However, if several eggs were fertilized at the same time, only two embryos should be transferred through the vagina to the uterus to avoid multiple pregnancies. The remaining oocytes can be saved thanks to cryopreservation.
The entire procedure lasts for a maximum of 20 days. For a first pregnancy test after ICSI you have to wait about five weeks. If the ICSI has succeeded, you can determine the date of birth with special pregnancy calculators.
For the couple the course of therapy remains the same as for IVF therapy. Ovarian stimulation treatment, egg retrieval and embryo transfer are carried out with ICSI as well as with IVF. The main difference to the conventional IVF method is only an additional step in the laboratory and concerns the handling of the egg and sperm cells. Sperm is usually obtained on the day of egg retrieval by masturbation. In principle, it can also be obtained from the testis (TESE) if no sperm can be detected in the ejaculate (semen sample).
With the ICSI method, the sperm is not added to the egg cells in the culture dish after the egg cell extraction (puncture), as with the conventional IVF method, but instead a sperm is brought directly into the egg cell under the microscope with the help of special glass needle , This method can be used for all mature egg cells obtained. A sperm, which does not necessarily have to be mobile, is required for the injection. The fertilization rate of the egg cells is therefore significantly increased with the ICSI method.
The transfer of the fertilized egg cells to the uterus (embryo transfer) generally takes place 2-3 days after the egg cell has been removed. The implantation phase begins in the following two weeks and is supported by controlling of a luteal hormone. The pregnancy test is performed two weeks after embryo transfer. The couples can take the test at the fertility center. Blood is drawn and the hCG value (pregnancy hormone) is determined. The result is known usually at the same day. Of course, the pregnancy test can also be carried out at your own gynecologist.
For whom is an ICSI suitable?
ICSI treatment is particularly suitable for couples who have a limited fertility, such as low or no fertile sperm in the seminal fluid (azoospermia).
Reasons for this may be antibodies against sperm, closed spermatic pathways or disturbed sperm production in the testes. If there are no sperms in the ejaculate, they may be obtained from the epididymis (MESA) or testes (TESE) through surgery. Even after a cancer therapy, when only frozen (cryopreserved) sperm cells are available, the ICSI promises success.
The ICSI can also help if the cause of the unfulfilled desire to have a baby can not be clarified (idiopathic sterility) or if both partners have a fertility disorder. Sometimes ICSI is a good method of artificial insemination for older couples.
Success chances of the ICSI
Egg and sperm cells do not have to find each other at the ICSI, this is done by the pipette. In principle, an egg and a sperm cell are sufficient for the ICSI. Therefore, even with a few sperm and poor sperm quality, the ICSI success rate is good. More than 70 percent of the eggs are fertilized.
The further course can not be predicted with certainty for the individual case. Individual factors, such as fertility and age, affect the ICSI success rate. After transfer to the uterus, about 15 to 20 percent of women become pregnant.
Many steps have to work together smoothly. If the fertilized egg has found its place in the uterus, the chances of a normal course of pregnancy are quite good, as with any other pregnancy.
Advantages and disadvantages of the ICSI
An advantage of the ICSI is the low starting material. Especially for men with bad spermiogram ICSI is a useful method. If sperm can not be found in the ejaculate, sometimes only a surgical procedure (TESE / MESA) can help, which can lead to complications.
For women, ICSI treatment starts with hormonal stimulation of the ovaries. In the worst case, overstimulation syndrome can take place. Low risks of infection or injury persist even after the puncture.