Intracytoplasmic Sperm Injection (ICSI)
Although cases presenting with mild sperm abnormalities can be successfully treated by "classical" IVF, today intracytoplasmic sperm injection (ICSI) offers a new dimension of therapy for all the moderate and more severe forms of male infertility. Indications for ICSI include:
- Men presenting with low sperm concentration, motility and / or morphology (irrespective of the degree of these abnormalities), antisperm antibodies, or with poor scores in the functional bioassays
- Cases of partial or total fertilization failure in a previous IVF attempt (with overt or more subtle sperm deficiencies or even with normal semen analysis)
- Men presenting with absence of sperm in the ejaculate (azoospermia). These cases were typically considered irreversible with donor sperm or adoption being considered as the only viable options. These challenging cases include two main types of problems:
- obstructive lesions of the male genital tract (such as congenital bilateral absence of the vas deferens, inflammatory occlusions, previous vasectomy, and others )
- patients presenting with different degrees of testicular insufficiency (hypospermatogenesis or poor sperm production of testicular origin). The former cases can be successfully treated by new techniques of sperm aspiration from the epididymis or the vas deferens followed by ICSI. In the latter cases, sperm can be obtained from the testes by performing an open testicular biopsy or by needle aspiration, also followed by ICSI.
In all these cases, the possibility of freezing "extra" sperm obtained at the time of the urological intervention (prior to or at the time of IVF/ICSI) should always be considered. Frozen - thawed sperm may maintain viability and therefore can be used in future ICSI cycles. Sperm freezing is a mandatory and efficient means of maintaining the reproductive potential of men who will have radical therapies in cases of curable cancer. Our sperm bank is CLIA - approved and serves local, out-of-state, and international physicians and patients.
There are probably several thousand babies born worldwide through ICSI. Worldwide registries note that in 97% or more of the times that ICSI results in delivery of normal healthy babies. These numbers are probably very close to the results achieved in standard IVF therapy and probably not far from natural reproduction.
However, we are learning more and more about incidences of chromosomal / genetic problems in the infertile man. New techniques are being developed; statistics quote approximately 10% incidence of genetic or chromosomal abnormalities in men with either severely low sperm counts (oligospermia) or lack of sperm in the semen (azoospermia). For this reason, and in addition to performing a chromosomal evaluation of the fetus (baby in the uterus) in early pregnancy either by chorionic villus sampling or amniocentesis, the Jones Institute recommends a genetic consultation.
There is some concern that ICSI could increase the incidence of male infertility in offspring and that it could enhance the occurrence of rare sexual chromosomal abnormalities. In nature, the most viable sperm reaches and fertilizes the egg; however, in ICSI, sperm are manually selected thus bypassing this natural selection process. Clinical data are not yet available to conclusively rule out this possibility. We recommend that men with severe oligospermia or non-obstructive azoospermic undergo a karyotype (blood chromosomal analysis) and an examination of presence/absence of microdeletions of a Y chromosome. Genetic counseling is offered as appropriate, including testing for Cystic Fibrosis mutations.