For those of you who are looking for a child - What is ICSI technology? (Intracytoplasmic Sperm Injection)

Dreaming of becoming a mother or a father is the greatest hope in everyone's heart. But sometimes, due to various reasons, that dream gets hindered. Difficulty conceiving a child, or infertility, is a problem that many people face in society today. So, at a time like this, there are many methods that can make that dream a reality with the help of modern medicine. Today, we are going to talk about one such very successful treatment method. That is the technology called ICSI (Intracytoplasmic Sperm Injection).

Simply put, what is ICSI?

The long name ICSI may sound a bit complicated. But its meaning is very simple. ICSI (Intracytoplasmic Sperm Injection) is a special method used to treat infertility, performed in a laboratory. Here, a single, healthy, well-selected sperm is carefully injected into one of the mother's eggs . The main goal of this method is to create an embryo by artificially fertilizing it.

You may have heard of IVF (In Vitro Fertilization). ICSI is another advanced and specialized step in IVF treatment. This method is especially helpful for those who have lost their children due to male infertility.

What does the word intracytoplasmic mean?

This is a bit of a scientific term. Simply put, there is a jelly-like substance inside an egg. We call it cytoplasm. Intracytoplasmic means "inside the cytoplasm." That means the sperm is injected into this part of the egg called the cytoplasm.

What is the difference between ICSI and regular IVF?

This is a question that many people have. Although ICSI is also part of the IVF process, there is a slight difference between the two. Think about it this way.

• Traditional IVF method: In this, the egg taken from the mother is placed in a special lab dish and thousands of sperm from the father are placed around it. Then, one of those sperms goes alone, pierces the egg, enters it, and waits for fertilization. This means that this is allowed to happen naturally. Sometimes, not even a single sperm may enter the egg.

• ICSI method: This is not the case here. Here, the best, healthiest sperm is selected and injected directly into the egg. It's like a special delivery service. This increases the chances of fertilization.

Both ICSI and IVF are called Assisted Reproductive Technology (ART) . This means that the process of combining eggs and sperm outside the body in a laboratory helps to conceive a child.

Who is ICSI treatment best suited for?

ICSI is especially recommended for men with male infertility issues. Below are some of the situations in which your doctor may suggest this treatment.

In addition, the ICSI method can be useful in several other cases:

• In cases where conventional IVF treatment has been attempted previously but no embryo has been created .
• If the woman who donates the eggs is over 35 years old .
• If previously frozen eggs or sperm (cryopreservation) are used for treatment.

How does the ICSI treatment process work?

This process consists of several key steps, all of which take place under the full supervision of your doctor and a team of specialists.

1. Preparation before treatment: egg and sperm retrieval

Before performing ICSI, you first need to obtain eggs from the mother and sperm from the father.

How to get eggs:

• Ovulation induction: Normally, only one egg is released per month. However, to increase the success of this treatment, multiple eggs need to be retrieved at once. For this, the woman is given several hormone injections over a period of 8 to 14 days. This stimulates the ovaries and causes multiple eggs to mature at once.
• Egg retrieval: After the eggs are mature, a very fine needle is inserted through the vagina under a light anesthetic and into the ovaries. The doctor uses transvaginal ultrasound to guide the retrieval. The eggs are carefully removed from the body using a device attached to the needle. This is painless.

How to obtain sperm:

Usually, sperm is collected on the same day as the eggs are collected.

• You should refrain from intercourse or masturbation for two to three days before donating sperm.
• You have to masturbate in a private room and collect your semen into a special container provided by the lab.
• This sample must be delivered to the laboratory within one hour.

In some cases (e.g., failure to ejaculate, blockage of the sperm ducts), it is necessary to surgically obtain sperm directly from the testicles.

2. In the lab: The ICSI process

Now is the crucial moment. Once the eggs and sperm are received, specialists perform the ICSI procedure in the laboratory.

1. A well-ripened egg is held in place with a very fine glass pipette.

2. Under a high-powered microscope, a single sperm with the healthiest, best motility is selected.

3. The selected sperm is taken with another fine needle, pierced through the wall of the egg, and injected into the cytoplasm .

4. Then carefully remove the needle.

3. After the process: Embryo development and implantation

After the sperm is injected, the egg is carefully monitored in the laboratory for several days to see if it is fertilized and becomes an embryo.

• A successfully fertilized egg divides into cells and develops into a stage called a blastocyst after 5 to 6 days.
• At this point, the healthiest, most developed embryo is selected and inserted into the mother's uterus. This is called embryo transfer .
• For this purpose, using ultrasound technology, a very fine tube called a catheter is inserted into the uterus through the vagina, and the embryo is implanted in the uterus.
• For pregnancy to occur, this embryo must attach itself well to the uterine wall and begin to develop there.

What are the benefits and risks of ICSI treatment?

Like any medical treatment, ICSI has benefits and some risks.

Benefits

The biggest advantage of this method is that it is more successful than traditional IVF in overcoming male infertility issues and providing parents with the opportunity to have children. In some treatment centers, ICSI is used for everyone, regardless of the cause of infertility, due to its high success rate.

Risks

Possible risks to the child

This is a concern for many parents. About 2% of children conceived naturally may have some health problem (congenital conditions) at birth. Some studies show that this risk may increase slightly by only 1%, or up to 3%, for children conceived through ICSI.

But medical experts believe that the reason for this increase may be the underlying cause of infertility , not the treatment itself. However, it is important to understand that this risk is very small.

There are several risks that may be slightly increased by the ICSI method:

• Angelman syndrome
• Autism
• Beckwith-Wiedemann syndrome
• Disorders of sex differentiation
• Hypospadias
• Intellectual disabilities

If you have any doubts or fears about this, talk openly with your doctor . He or she will explain this to you further.

When should you see a doctor?

If you experience any of the following symptoms after ICSI treatment, call your doctor immediately.

• Symptoms of an ectopic pregnancy: Symptoms of an embryo implanting outside the uterus (e.g., in a fallopian tube) (such as severe pain on one side of the abdomen, vaginal bleeding).
• Signs of an infection: fever, chills, and excessive vaginal discharge.
• Symptoms of miscarriage: Heavy bleeding, severe abdominal pain.
• Symptoms of premature birth: Uterine contractions that occur before the due date.

Is the risk of having twins higher?

To increase the success rate of your pregnancy, doctors may decide to transfer more than one embryo (e.g., two) to your uterus. If this happens, you may have twins or triplets. Carrying multiples increases the risk of complications for both the mother and the baby, such as premature birth. Therefore, it is important to discuss how many embryos to transfer with your doctor.

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