Once the couple has been assessed and the ICSI indication formalized, the following steps have several aspects in common with the classic IVF program, with the exception of the gamete micromanipulation itself

MAIN STEPS

Controlled stimulation of the ovaries.

Puncture of follicles and aspiration of oocytes.

Denudation of oocytes and classification *.

Micromanipulation of gametes and in vitro culture *.

Embryo transfer.

Luteal phase support.

* These two stages are the ones that differentiate this program (ICSI) from the classic IVF program (IVF).

This technique is possible to be used in all patients who ovulate normally. Young women who want to avoid ovarian stimulation with hormones can try the natural cycle beforehand. We also have very good results in older women and those who previously had little response to conventional induction. It is the treatment indicated for women who – for reasons of choice and conception – do not want to use medications for controlled ovarian stimulation. We include in these conditions women who cannot receive hormones due to the risk of developing hormone-dependent neoplasms (cancer) (such as breast, for example). It is a safer and healthier technique than conventional treatment that employs hormones in high doses.

DETERMINANTS OF SUCCESS WITH ICSI

The three classic parameters of the spermogram, concentration, motility and morphology, do not seem to influence the result with ICSI. However, there is some discussion regarding the morphology.

Some authors believe that morphology has an influence on the implantation rate, while others believe that there is no influence of morphology on the implantation rate. All are invariable in pointing out the woman’s age, that is, the quality of the ovarian reserve as the main responsible for the success in this Program. With the ICSI technique, pregnancy rates between 40-50% per cycle can be expected.

ARE THERE GENETIC RISKS FOR PROLE WHEN WE USE ICSI?

The use of ICSI offers an effective treatment for patients with severe male factor. If there are viable sperm, the pregnancy rate is not affected by the quality of the semen because this technique crosses the pellucid zone and the oolema to transfer the male genome directly into the ooplasm of the oocyte.

ICSI can also be performed on azoospermic men, since sperm can be obtained from the epididymis or testis. However, as the sperm used for fertilization is selected by the operator, and not naturally selected by the female reproductive tract, the pellucid zone or the oolema, concerns have been raised about the transmission of genetic abnormalities to the next generation. Although there are articles in the literature pointing to a higher incidence of abnormalities related to the sex chromosome, ICSI is compatible with the birth of healthy children, and it is a procedure that can no longer be considered experimental.

A study with a large number of children born by the ICSI technique (Bowen, 1998), concludes that these two-year-old children  had the same development as children born by the conventional in vitro fertilization technique, and both groups showed a greater development than those born to fertile parents by natural reproduction.

Another more recent study (Maher et al, 2003), shows that assisted reproduction techniques, especially ICSI, increase the risk of the birth of children with Beckwith-Wiedemann and Angelman Syndromes. Still, these risks are extremely low, not contraindicating treatment.

References in Medical Literature:

• Bowen et al. Medical and developmental outcome at 1 year for children conceived by intracytoplasmic sperm injection. Lancet. 1998 May 23;351(9115):1529-34.
• Maher et al. Beckwith-Wiedemann syndrome and assisted reproduction technology (ART). J Med Genet. 2003 Jan;40(1):62-4.