Monday, 2 December 2013

ICSI(Intra Cytoplasmic Sperm Injection)

ICSI (Intra Cytoplasmic Sperm Injection):

ICSI by Dr. Arun
When the number of good quality sperms are low IVF cannot be performed . In such cases, eggs can be directly fertilized by injecting the sperm into the egg by the help of sophisticated micromanipulator. This process is called ICSI.

Severe oligospermia, asthenospermia,Teratospermia due to any cause. Azoospermia (absence of  sperm) due to any cause can also treated by ICSI after obtaining sperms by aspiration team testis. (TESE, TESA, PESA)

 (1)  Initial consultation for detailed evaluation, fitness tests with blood and urine tests, Mock Embryo Transfer (MET), Counseling, Consent form completion etc are done in O.P setting.
Consent forms include:-
  1. Consent for ICSI
  2. Consent for embryo freezing
  3. Consent for OR/GA
  4. Consent for ET(embryo transfer)
  5. Consent for Laparoscopy (if required only)

       About procedure, method, duration, cost, side effects, success, frequency of visits etc: - are given
     Fitness Tests:-
    1. Detailed history of both(husband&wife)
    2. Medical examination of both partners
    3. Lab tests for blood routine, sugar levels, hormone levels like LH, FSH, TSH, prolactin, infection screening HIV, hepatitis, syphilis
    4.  USS(Scan) is a must to check pelvis , and is done by Gynaecologist herself.

      MET (Mock Embryo Transfer):-
      Trial of embryo transfer, without actual embryo is conducted to check the position, length and ease of E.T. This helps doctor to decide how to perform E.T. Some time , sedation is given if patient is anxcious.
      Dilation (D&C) is done with GA if Cervix is tightly closed.
      Different type of harder cannula is used if cervix is curved.
      Infections detected in Cervix/Vagina are treated accordingly.
      (2)    Ovarian Stimulation:- Ovaries are stimulated by daily injections (FSH) starting D2 or D3. They are small injections given just under skin and needs to be taken daily for 9-12 days.
         Doctors will check the growth of follicules by scan on and off. When the eggs are matured , that is when it is around 20 mm, a final injection with  hcg is given.
      Egg collection (OR) is done under sedation/GA after 36 hours of hcg injection.

      (3)    Egg Collection (OR)
      The doctor uses a small long needle guided through the vaginal scan
      probe, to collect the fluid from the follicles. This is done with extreme
      precision, with the doctor watching the needle on scan, all the time, to avoid  injury to other internal organs.
      (4)    Embryology:-
      All the follicles are tapped using suction force, and the eggs which are obtained in the fluid are identified in the fluid are identified by the embryologist under specialized microscope in the IVF lab. The eggs are then mixed with washed sperms from husband, to fertilise on its own.
      The embryologist will check the embryos for growth , daily and will provide media for its growth and keep it in an incubator,  which provides set temperature & PH for the growth.

      (5)    Embryo Transfer (ET):-
      They are transferred on D3 or D5 into the uterus by Embryo transfer(ET). The technique of ET is highly skilled procedure. As they are very delicate, the  embryos need to be handled in a very gentle manner and they are loaded in very soft,  non toxic cannula.
      Difficulty, or presence of blood suggest high chances of failure. So the ET is  performed with great concentration and high precision.
      The skill and presence of mind of the doctor is crucial in this final step. Performing Yoga and listening to relaxing music helps in more accurate ET. Artistic skills may be helpful in this particular procedure. Doctors who are too busy or nervous should not do ET as valuable embryos will be lost.

      (6)    Luteal Support:-
      Medicines are given to support the growth of the baby as Vaginal preparations or sometimes as injections, called Luteal support.
      They need to be Report properly according to the advice given.

      (7)    Pregnancy Test:-
      UPT is done by 14th day to check result. Blood test (bhcg) can also be done.Depending on the result, doctors will give further advises.
      FET (Frozen Embryo Transfer):-  
      Embryos can be frozen if there are excess embryos. They are transferred (FET) later months according to cycle.

      In cases if pregnancy does not occur due to failure of implantation or poor embryo quality, doctors will counsel to provide further options
      and to clarify your doubts.

      Success Rate:-
      Depends on quality of egg and sperm and physicians skill also plays a part. Generally we have 60% success in young healthy couple, 30% success in
      in aged (more than 35 years) we discourage IVF after 40, and offer DE if willing.

      Chances of abnormality:
                There is slightly increased chance of abnormality in baby in ICSI (2%) composed to IVF (1%) of general population (1%). It is quite logical to know that genetic abnormalities which may cause sperm problems will be, obviously transmitted to next generation.
              Again, the success depends on quality of eggs and sperms . Our embryologist is highly skilled and the can offer 60% success if gametes are healthy.