Intracytoplasmic sperm injection

Intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) refers to a technique in which a single sperm is injected directly into the cytoplasm of a mature oocyte. This procedure is performed as part of an in vitro fertilization (IVF) cycle, and provides an effective method for assisting fertilization in men with suboptimal semen parameters or who experienced no or low fertilization rates after conventional IVF
 It is an extension to conventional in vitro fertilisation (IVF) treatment, can be applied in cases where there is low sperm number, motility or morphology, or a combination of these parameters. ICSI can also be used in cases where sperm have been retrieved surgically from the epididymis or testicular tissue and in cases where the polyspermy rate from IVF has been unexpectedly and unacceptably high. Although the injection of motile and morphologically normal sperm is the most common route (following immotilisation), immotile sperm can also be used where no motile sperm is seen in a sperm sample but where viability of the sperm can be confirmed 

ICSI was first applied to human gametes in 1988; it was first used in cases of fertilization failure after standard IVF or when few sperm cells were available. The first pregnancies were reported in Belgium in 1992  

This technique has consistently demonstrated higher fertilization rates than prior micromanipulation techniques and produced more embryos with higher implantation rates  

The capacity of ICSI to permit almost any type of spermatozoa to fertilize oocytes has made it the most successful treatment for male factor infertility. In 2016, IVF with ICSI comprised 66 percent of initiated assisted reproductive technology (ART) procedures in the United States  

The use of ICSI in the United States has increased dramatically since 1995, without a proportionate increase in diagnosis of male factor infertility  

The use of ICSI for male factor infertility increased from 84 percent in 2003 to 93 percent in 2012. Worldwide, there is geographic variation in the use of ICSI with IVF  

Since then, an estimated seven million pregnancies have been achieved worldwide by IVF and its modifications, known generically as assisted reproductive technologies (ARTs)  

•    Pretreatment Evaluation:
A thorough evaluation of the male patient, including semen analysis, sperm morphology, and urology consultation is warranted. Although controversial, some authorities also utilize additional tests such as sperm antibody testing and a wide spectrum of spermatozoa function tests ranging from, but not limited to, hamster-spermatozoa penetration assay, hemi-zona assay, mannose binding assay, hypo-osmotic swelling test, and acrosome reaction assay for identifying couples at risk for reduced or no fertilization with conventional IVF 

In males with severe oligospermia or azoospermia, additional testing may be recommended.
The most common genetic factors associated with male infertility are cystic fibrosis gene mutations (associated with congenital absence of the vas deferens), structural chromosomal abnormalities (eg, aneuploidy, inversion, translocation) associated with impaired testicular function, and Y chromosome microdeletions (associated with impaired spermatogenesis). Cystic fibrosis is associated with a mutation of the cystic fibrosis transmembrane conductance regulator gene. Men who carry this gene may not have the classic clinical manifestations of cystic fibrosis

Structural chromosomal abnormalities in peripheral lymphocytes are observed in 10 to 15 percent of azoospermic men, 5 percent of oligospermic men, and less than 1 percent of normospermic men. The partners of these men are at increased risk of miscarriage and progeny are at increased risk of congenital anomalies 

Detectable microdeletions of the Y chromosome are found by polymerase chain reaction in 10 to 15 percent of men with azoospermia or severe oligospermia. This is probably an underestimate since microdeletions that are nondetectable by current techniques likely exist. Sons of men with microdeletions will inherit the microdeletion and thus be at risk for infertility. 

Affected men are counseled about the risk of inherited spermatogenesis failure in male offspring and options such as sex selection and preimplantation genetic diagnosis. The American Society of Reproductive Medicine (ASRM) recommends that karyotyping be offered to men who have nonobstructive azoospermia or severe oligozoospermia (defined as less than 5 to 10 million sperm/mL) prior to performing ICSI with their sperm 

ACOG Committee on Obstetric Practice, ACOG Committee on Gynecologic Practice, (2015): ACOG Committee on Genetics. ACOG Committee Opinion #324: Perinatal risks associated with assisted reproductive technology. Obstet Gynecol 2015; 106:1143.
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Almasi-Hashiani, A., Mansournia, M. A., Sepidarkish, M., Vesali, S., Ghaheri, A., Esmailzadeh, A., & Omani-Samani, R. (2018).