Intracytoplasmic sperm injection

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IVF and ICSI

What is meant by IVF?

IVF stands for Invitro fertilization which means putting the sperms with the ova in a dish in the nursery waiting for spontaneous fertilization through the penetration of the ova by sperms without interference

What is meant by ICSI?

ICSI stands for Intracytoplasmic sperm injection which is the injection of sperm into the oocytes cytoplasm under the microscope by the embryologist

 

Steps of IVF and ICSI procedure

  1. The stage of preparation of the ovaries and endometrium before ovarian stimulation (called down regulation of the pituitary gland)

  • This stage does not apply to all women, but applied according to the selected plan (protocol)
  • In the case of preparation before stimulation, it can be done through pills and injection to be taken under the skin for about three weeks
  • This preparation can be confirmed by hormonal profile and ultrasound
  • If preparation is not needed by the selected protocol, ovarian stimulation is started immediately from D2 of menses
  • The choice of protocol, whether it will contain a preparatory stage or not, is done according to the situation of the wife and other considerations such as age

2-Controlled ovaries stimulation:

  • Ovulation is stimulated by injecting pituitary hormones (FSH, LH) in a period of approximately two weeks starting from the second day of the cycle,
  • The process of ovarian stimulation is followed by vaginal sonar and the tests of some hormones at each follow-up visit, to complete the next dose according to patient’s response
  • The ovary is stimulated until the diameter of the follicles reaches the required size (from 18 to 22 mm) and the trigger injection to complete the final stage of the growth of the eggs and the endometrium and to prepare foe ovum pick up

3 – Stage of the trigger

  • The trigger is hCG hormone and is taken deeply in a muscle such as the buttocks at the specified time by the doctor without changing the date of administration.
  • Function of the trigger: it stimulate the final stage of egg and endometrial maturity, and stimulate the process of ovulation after 36 hours

4- Stage ovum pick up

  • The oocytes are aspirated under general anesthesia 34 hours after the trigger, through a needle with the help of vaginal sonar. These eggs are then given to the embryologist to initiate procedures for the processing of eggs and sperm and perform ICSI.
  • At this stage, the true number of eggs actually withdrawn is shown.

5 – Stage of performing ICSI by the following steps:

  • Egg peeling
  • Sperm collecting and injection into the egg under the microscope
  • Putting the eggs after the injection process within the incubation of embryos
  • Monitoring the egg that has been injected under the microscope to confirm fertilization
  • Monitoring the embryos daily to ensure the continuation of the process of divisions that occur daily with daily evaluation of the embryos to determine the date of embryo transfer

6- Stage of embryo transfer

  • Embryos are transferred on the third or fifth day of ovum pickup according to the vision of the embryologist after the classification of the status and growth of the embryos
  • The couple is contacted to inform them about the date of embryo transfer
  • Embryo transfer does not need anesthesia

7- Pregnancy test

Digital (quantitative) pregnancy test is done according to the day of embryo transfer

  • In case of Day 3 embryo transfer: Pregnancy test is done after 11 days of embryo transfer
  • In case of Day 5 embryo transfer:: Pregnancy test is done after 9 days of embryo transfer
  • Pregnancy test is repeated two days after the first test to ensure doubling which indicate an intrauterine pregnancy

 

Who need ICSI?

  • Cases of bilateral tubal block after failure of the laparoscope to treat it
  • Cases of delayed pregnancy due to unknown cause and unresponsive to other means of treatment
  • Severe male factor
  • The lack of sperm in the husband because of the presence of blockage, which needs to extract sperm through the taking of a sample of the testicle (testicular biopsy)
  • Cases of severe ovulation weakness and cases of absence or blockage of the cervix

Pre-implantation Genetic Diagnosis (PGD) and fetal sex determination

Embryos can be genetically examined to ensure that the embryos are free from hereditary diseases or to determine the type of embryo by examining the cell of each embryo after specific stages of division to identify the sex of each embryo by determining the sex chromosome, then embryos of the required sex are transferred to the uterus, and this step has a separate cost.

 

Embryo Freezing

  • If extra embryos are available after the transfer and are valid for freezing, the couple is asked if they want to freeze the embryos. This step will have a separate cost.
  • The result of freezing embryos is not known until the embryos are unfreezed again before they are returned to the uterus

Frozen embryos transfer (FET)

  • The endometrium is prepared by medications without ovarian stimulation.
  • Embryos transfer must be done after 5 to 7 days from preparation depending on the day that the embryo was frozen (frozen on day3 or day 5 of ovum pickup)

How sperms are collected for ICSI and IVF?

Sperm can be extracted through one of the following methods depending on the condition of the husband

1- Natural sample

By masturbation on the same day of ovum pickup and the sample should be taken after abstinence from sexual intercourse for at least 5 days

2 -Testicular biopsy

a testicle sample can be done before the ovum pickup day with freezing of the sample for use in the injection on the ovum pickup day, and can be done on the same day as the ovum pickup day also as the doctor’s opinion

 

Freezing of semen sample

  • Both samples can be frozen in the following cases:
  • The absence of the husband on the day of ovum pickup for reasons of traveling
  • Severe weakness of the husband and the availability of a limited number of sperm: In this case the freezing of the semen sample is mandatory and also another sample is requested on the day of ovum pickup to provide fresh sperms
  • Cases from the testicular biopsy: The sample is frozen for use on the day of withdrawal.

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Dr. Mohamed Sehsaah

Dr. Mohamed Sehsaah is an Egyptian doctor who grew up in the united Arab Emirates (UAE) and then he obtained the medical degree from Egypt.
He obtained the master’s degree in obstetrics and gynecology from Ain- Shams University in Cairo, with a special study and research in the field of recurrent miscarriage, to become a specialist in obstetrics and gynecology.

He joined the Royal College in the UK and passed the first part of the British Fellowship (MRCOG)