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    Intracytoplasmic Sperm Injection (ICSI) Treatment Procedure

    Ntracytoplasmic Sperm Injection (ICSI) is a specialised form of In Vitro Fertilisation (IVF) that is used primarily for the treatment of severe cases of male-factor infertility. ICSI involves the injection of a single sperm directly into a mature egg.

    PROCEDURE OF ICSI

    Step 1: Hormone stimulation

    The first step of the treatment is for the woman to take reproductive hormones to stimulate the production of eggs in the ovaries.

    Step 2: Egg retrieval

    When the eggs have developed, they are removed from the woman’s ovaries with a small needle under short GA.

    Step 3: Fertilization of eggs in the laboratory

    Sperm cells from the male partner’s sample or from a donor sperm sample are selected. One single sperm cell is injected into each egg. The procedure is carried out with a fine needle that places the sperm cell inside the cytoplasm of egg.

    Step 4: Development of eggs in an incubator

    The eggs are placed in an incubator and they will develop into embryos in couple of days.

    Step 5: Fertilized eggs are transferred to the uterus

    One or more embryos are then placed in the uterus and a pregnancy will occur.
    ICSI is often recommended to Couples who have had poor or no fertilization during a standard IVF, as well as Couples where Male Partner has: a very low sperm count. a high percentage of abnormally shaped sperm. ... a vasectomy reversal that was unsuccessful or resulted in a very low sperm count or very poor quality sperm
    Specific Situations Where ICSI Might Be Recommended
    One such factor in men which decreases the chances are low sperm count. There are various reasons which can lead to this situation such as the person is overweight, lifestyle factors (drinking and smoking), low sperm count, poor sperm motility or movement, poor sperm quality, spermatozoa that do not have the ability to penetrate an egg or azoospermia.
    There are two types of azoospermia:
    Obstructive and non-obstructive.

    Obstructive azoospermia:

    • Previous vasectomy
    • Congenital absence of the vas
    • Scars from previous infections
    Non-obstructive azoospermia :

    It occurs when a defective testicle does not produce spermatozoa. In the case of azoospermia, the likelihood of obtaining usable spermatozoa is low and the possibility of using donor sperm can be considered.

    In Vitro Fertilization (IVF) and Embryo Transfer (ET)

    IVF is the process of fertilization by extracting eggs, retrieving a sperm sample placed together in a plastic dish for fertilization. Manually combining an egg and sperm in a laboratory plastic dish for fertilization.. After fertilization the resulting embryos are then transferred to the women’s uterus with the intent to establish a successful pregnancy.

    The IVF Procedure

    It is a process by which an egg is fertilised by sperm outside the body: in vitro. IVF. Mature eggs are collected (retrieved) from ovaries and fertilized by sperms in a fluid medium in a laboratory. Then the fertilized egg or eggs are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

    Stimulating of the ovaries

    Ovarian stimulation is the process of inducing ovarian follicular development and oocyte maturation using medications. Stimulation can be used in order to produce more than the usual one egg per cycle. For IVF you’ll be frequently monitored using hormonal testing and vaginal ultrasounds for the best result. Once an ultrasound determines you have a sufficient number of follicles the collection of eggs at precisely the right time.

    Egg Retrieval/ Collection of the eggs

    An ultrasound probe is inserted into your vagina to identify follicles, and a needle is guided through the vagina and into the follicles under a light/short anaesthesia. The eggs are removed from the follicles through the needle, which is connected to a suction device

    Fertilisation and embryo transfer

    The mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. A zygote or pre-embryo will begin to develop. The pre-embryo remains in the incubator for one or two days, until it has divided into two or four cells stage. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. In this process Two to three embryos will be transferred to the uterus using a soft, fine catheter. This procedure (known as embryo transfer) is quite painless, similar to a smear test, and requires no anaesthesia.

    Pregnancy test results

    After Embryo transfer within Two weeks blood test (Beta HCG) is taken to determine if the woman is pregnant.

    Intrauterine Insemination ( IUI) ( Husband / Donor)

    A type of artificial insemination — is a procedure for treating infertility. Sperm that have been washed and concentrated are placed directly in your uterus around the time your ovary releases one or more eggs to be fertilized.

    Who does IUI help

    Couples may begin with IUI before progressing to IVF if needed. IUI may be the only treatment needed to achieve pregnancy. Low sperm count or decreased sperm mobility are the common reason for intrauterine insemination (IUI).IUI can be performed using a male partner’s sperm or donor sperm.

    IUI is most commonly used in these scenarios:

    • unexplained infertility
    • mild endometriosis
    • issues with the cervix or cervical mucus
    • low sperm count
    • decreased sperm motility
    • issues with ejaculation or erection
    • same-sex couples wishing to conceive
    • a single woman wishing to conceive
    • a couple wanting to avoid passing on a genetic defect from the male partner to the child

    IUI isn’t effective in the following scenarios:

    • women with moderate to severe endometriosis
    • women who have had both fallopian tubes removed or have both fallopian tubes blocked
    • women with severe fallopian tube disease
    • women who have had multiple pelvic infections
    • men who produce no sperm (unless the couple wishes to use donor sperm)
    Risk of Intrauterine Insemination

    Intrauterine insemination is a relatively simple and safe procedure, and the risk of serious complications is low. The risks of IUI are not severe and there is only a slight possibility of serious complications.

    The risk of IUI :

    Multiple pregnancies/ Twins, Triplets, Or More From IUI
    Pregnancies of multiples are the most common and the risk associated with IUI. IUI risk slightly higher when coordinated with ovulation including medications 1 - 14% of pregnancies involve multiple gestations.

    Spotting: There might be small vaginal bleeding due to the placement of the catheter in the uterus. But this bleeding does not have any effect on the chance of pregnancy.

    PROCEDURE TIMING FOR IUI

    The visit for intrauterine insemination takes about 15 to 20 minutes and is usually done in a doctor's office or clinic. The IUI procedure itself takes just a minute or two and requires no medications or pain relievers

    During the procedure

    1. Attaches a vial containing a sample of healthy sperm to the end of a long, thin, flexible tube (catheter)
    2. Inserts the catheter into your vagina, through your cervical opening and into your uterus.
    3. Pushes the sperm sample through the tube into your uterus.
    4. Removes the catheter, followed by the speculum.

    PROCEDURE AFTER INSEMINATION

    Recommend patients lie down on the table for 15 – 30 minutes after the procedure on the table. You can dress up and go on about your daily activities, once the procedure is done. You may encounter some spotting a day or two after the procedure.

    Success rates of IUI

    On average, a woman under 35 will have a 10 to 20 percent chance of pregnancy with each IUI, while a woman over 40 will have a two to five percent chance. “The peak IUI effect is around three to four cycles.
    Though IUI is a less expensive and less invasive option. The pregnancy rates from IUI are lower than IVF. If you are interested in IUI, you might want to talk to a doctor.

    Results:

    You should wait for two weeks before taking the pregnancy test.

    Ovulation Induction and Controlled Ovarian Stimulation

    Ovulation induction and controlled ovarian stimulation lie at the very heart of treatment for infertility. Ovulation induction involves taking medication to induce ovulation by encouraging eggs to develop in the ovaries and be released, increasing the chance of conception through timely sexual intercourse, intrauterine inseminations and in vitro fertilization procedures can be scheduled at the most likely time to achieve pregnancy.
    For infertile couple monitoring the woman’s menstrual cycle and providing them with accurate dates to proceed with the suggested mode of treatment.