IVF / ICSI

In Vitro Fertilisation (IVF) / ICSI

For a man’s sperm can fertilize a woman’s egg, the head of the sperm must attach to the outside of the egg. Once attached, the sperm pushes through the outer layer to the inside of the egg (cytoplasm), where fertilization takes place.

 

There are two ways that an egg may be fertilized by IVF:

• Traditional IVF
• Intra cytoplasmic sperm Injection (ICSI)

In traditional IVF, 50,000 or more swimming sperm are placed next to the egg in a laboratory dish. Fertilization occurs when one of the sperm enters into the cytoplasm of the egg (Oocyte) .

In the ICSI process, a tiny needle, called a micropipette, is used to inject a single sperm into the center of the egg. With either traditional IVF or ICSI, once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 1 to 5 days before it is transferred to the woman’s uterus (womb).

ICSI is indicated when sperm cannot penetrate the outer layer of the egg. This could be due to a variety of reasons.The egg’s outer layer may be thick or hard to penetrate or the sperm may be unable to swim. In these cases, a procedure called intracytoplasmic sperm injection (ICSI) can be done along with vitro fertilization (IVF) to help fertilize the egg. During ICSI, a single sperm is injected directly into the cytoplasm the egg.

Stages of embryo development

Day 0 – The day of egg pick up is Day 0. This is when the male partner gives the sperm sample and ICSI is performed. Post ICSI the eggs are placed in the incubator for fertilisation and further development.

Day 1 –  Our embryologist will be checking the eggs for fertilisation. The fertilised eggs are now known as embryos.

Day 3 (Cleavage stage)

The embryos undergo rapid cell division post fertilisation. Day 3 embryos are called Cleavage stage embryos. Our doctors may decide for an embryo transfer at this stage in some patients based on the patients history.

Day 5 (Blastocyst)

Day 5 embryos are called Blastocysts, This is a way of natural selection as embryos as poor quality does not progress to become a blastocyst.

Once embryos reach this phase, they get transferred into the uterus as a Fresh or Frozen embryos. The decision regarding fresh and frozen transfer will be taken by your treating physician. Fresh embryo transfer happens either on D3 or D5 after egg retrieval.

Why would I need ICSI?

ICSI helps to overcome fertility problems, such as:

• The male partner produces too few sperms.
• The sperm have poor motility.
• The sperm may have trouble attaching to the egg.
• A blockage in the male reproductive tract may keep sperm from getting out.
• Eggs have not fertilized by traditional IVF, regardless of the condition of the sperm.
• In vitro matured eggs are being used.
• Previously frozen eggs are being used.

ICSI fertilizes up to 80% of eggs. Risks of ICSI includes egg damage, fertilisation failure or embryo arrest. But no concrete evidence has been derived on these. After fertilization, the chance of giving birth to a baby is the same if they have IVF  or ICSI.

Success rates:

Success depends on the following factors

1. Quality of sperms disorder
2. Availability of good quality mature eggs.
3. Quality of Endometrium for implantation

Many a times its difficult to ascertain the reason behind an unsuccessful IVF cycle post embryo transfer.

 

 

Risks

Ovarian Hyperstimulation Syndrome (OHSS) – This condition is observed in women who have a good ovarian reserve. There is excessive response to the medications given to stimulate eggs in the ovary.

Ectopic pregnancy – Pregnancy implanting in the wrong location other than within the womb.

Multiple pregnancy (Twins / Triplets) –  This risk is dependent on the number of embryos transferred. Very rarely one embryo can divide into two babies.