My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
The doctor walked in with a smile on his face. Well kids, looks like you are having a baby! Lilly and Maria looked at each other in shock. It was almost too good to be true.
They had waited so long already, but the past few weeks had been the most stressful. Their treatments to conceive included tests, medication injections, and sperm donor paperwork. Their doctors had been hopeful and encouraging but they all knew the risks of failure were significant.
As the truth dawned on them, they began to celebrate. As they embraced and shared a kiss, they couldn’t help but dream about the day their baby would be placed into their arms.
This scenario has played itself out with so many people in so many fertility clinics, hospitals, and doctors offices over the years. More and more people have experienced the joys of becoming parents with the assistance of medical treatments.
Technology has come a long way, and with it, many options for those wanting to have children have been developed. One of those options is ICSI. Today I want to look at the ICSI procedure, explore how it works, and how it can help someone conceive a child.
ICSI is an acronym which stands for intracytoplasmic sperm injection. The treatment is similar but in vitro fertilization (IVF) but, during the ICSI process, sperm is injected directly into an egg to fertilize it.
The embryo created is then transferred to the uterus. Pregnancy could be the result.
Let’s look at the ICSI procedure step by step.
In order to combine the sperm and egg, it is necessary to collect them. The process and testing for each is different.
The process an egg goes through from ovary to pregnancy is quite complex. Each step is crucial, and many eggs may be collected at a time.
Fertility medications may be used to stimulate the female’s ovaries in order for more eggs to be released. These are administered via injection by a doctor who regulates each dose carefully.
The eggs must be mature in order to be good candidates for fertilization. A mature egg will have gone through two rounds of cell division.
Guided by an ultrasound, a doctor will extract the eggs using a needle inserted into the ovary. The eggs are held in the fluid in each follicle. After retrieval, the eggs will likely be fertilized with the sperm within four to six hours.
Sperm can be used, either from the potential parent, or a sperm donor. The process is a bit more straightforward than egg collection. For one thing, no medication or injections are required for this step unless the male is unable to produce a sample manually.
ISCI is most beneficial for people who experience low sperm count, low motility, and other male infertility woes.
One study titled One Follicle, One Egg, One Embryo: A Case-report of Successful Pregnancy Obtained From a Single Oocyte Collected highlighted: “The introduction of intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility, in particular, for patients with low sperm counts.”
Another study called Evaluation and assessment of semen for IVF/ICSI concludes: “The combination of semen analysis with advanced sperm function tests provide important diagnostic and prognostic information for male infertility and is crucial for selection of patients for treatment with IVF or ICSI.”
The sperm is extracted from the ejaculated semen collected in a container, or it may be retrieved surgically. The semen is tested for live sperm. The live sperm is then isolated and transferred via needle to be injected into the egg.
Once the egg and sperm have been collected, it’s time to fertilize the egg. The term “intracytoplasmic” refers to the part of the egg that is injected with sperm.
During ICSI, the sperm is injected directly into the cytoplasm of the egg. This is a substance in the center of the egg which has a gel-like consistency.
One sperm is injected directly into one egg’s cytoplasm. Though this does not guarantee successful pregnancy, it is a more direct way to fertilize an egg than in IVF. IVF happens when the collected egg and sperm are put into a dish together in hopes one of the many sperm will find and fertilize the egg.
When the egg is successfully fertilized, the newly created embryo is then transferred into the uterus. This process is done through a long thin tube called a catheter. With the assistance of ultrasound technology, the embryo is passed through the cervix into the uterus then released.
Once the embryo is released into the uterus it can attach itself into the lining of the uterus and begin the process of development into a fetus. Once the embryo has successfully implanted into the uterus, pregnancy is achieved.
The success of sperm injection for pregnancy really depends upon each individual sperm, egg, and uterus. However, for some it is their best chance.
In a study called Intracytoplasmic Sperm Injection: State of the Art In Humans we learn: “To date, ICSI (Palermo et al. 2014d) has been responsible for over two million babies worldwide and has supplanted prior assisted fertilization techniques due to its ability to successfully bypass zona pellucida irregularities and circumvent the presence of antisperm antibodies, sperm acrosome dysfunction and sperm kinetic defects.”
The excerpt below demonstrates the hope that has been made possible through ICSI, that, for many, was not available before. As always, a qualified medical professional can tell someone if their specific situation could be most helped by the assistance of ICSI treatment.
A study called,The Cost Effectiveness of Intracytoplasmic Sperm Injection (ICSI) revealed: “Previously, fathering a child was virtually impossible for patients with untreatable azoospermia or other severe sperm abnormalities, options being limited to artificial insemination using donor sperm, adoption or ultimately remaining childless. The introduction of ICSI provides the possibility of having a child that is genetically linked to both parents.”
As discussed above, fertilization rates with ICSI might increase for males with fertility difficulties. For others, IVF may be a better solution.
In a study called Comparison of Conventional IVF Versus ICSI in Non-male Factor, Normoresponder Patients we learn: “In IVF group, fertilization and implantation rates were significantly higher than ICSI group (66.22% and 16.67% in IVF group versus 57.46% and 11.17% in ICSI group, respectively). Chemical and clinical pregnancy rates were statistically higher in the IVF group as compared with the ICSI group (42.9% vs. 27.3% and 35.7% vs. 21.5%, respectively).”
One factor to consider, outside of fertility issues, is cost. Let’s look at that now.
ICSI treatment cost varies depending on where you have it done, and how many times the procedure is carried out also affects the overall financial impact. Intracytoplasmic sperm injection cost in general is about $800-$2,500 in the US.
An ICSI, IVF cost comparison reveals on average ICSI to be much less expensive per cycle. For example, in the US, IVF treatment costs can range from $10,000 to $25,000 per cycle.
In the UK, ICSI can cost between £600-£2,600 with additional costs for storing embryos and using donated sperm. This figure doesn’t tend to include egg stimulation. IVF can range between £3,500-£7,000 with additional costs for using donated eggs, sperm, and freezing embryos.
The timeline for ICSI is around four to six weeks. This can vary from person to person.
The stimulation of ovaries to release more eggs can take up to two weeks. Once the eggs are ready for retrieval, less than 24 hours is needed for that procedure. When fertilization occurs, embryo transfer can take place around two to five days after unless the embryos are being frozen for use at a later date. Two weeks later a test can be performed to see whether or not implantation has been achieved and pregnancy is confirmed.
The two weeks between embryo transfer and confirmation of pregnancy can be extremely stressful and exciting all at once. For those who have been through this agony, this period is referred to not so affectionately as the Two Week Wait.
The struggle of infertility is a rough one. Many people dream of being parents and go through the often painful medical procedures to see their dreams come true.
No matter how a child is conceived, parenthood comes with sacrifice. Parenthood starts with your heart first.
When the waiting and repeated treatments give way to a successful pregnancy and birth of a child, the joy often exceeds expectations. I have never met a single person that would say it wasn’t worth it to hold their baby.
With new technology becoming available, more and more people are being able to expand their options. ICSI is just one more on the list. If you or someone you know is considering this particular treatment, please know there is hope and there is support.
Palermo, G. D., O’Neill, C. L., Chow, S., Cheung, S., Parrella, A., Pereira, N., & Rosenwaks, Z. (2017). Intracytoplasmic sperm injection: state of the art in humans. Reproduction (Cambridge, England), 154(6), F93–F110. https://doi.org/10.1530/REP-17-0374
Hollingsworth, B., Harris, A., & Mortimer, D. (2007). The cost effectiveness of intracyctoplasmic sperm injection (ICSI). Journal of assisted reproduction and genetics, 24(12), 571–577. https://doi.org/10.1007/s10815-007-9175-0
Eftekhar, M., Mohammadian, F., Yousefnejad, F., Molaei, B., & Aflatoonian, A. (2012). Comparison of conventional IVF versus ICSI in non-male factor, normoresponder patients. Iranian journal of reproductive medicine, 10(2), 131–136.
Liu, D. Y., & Baker, H. W. (2002). Evaluation and assessment of semen for IVF/ICSI. Asian journal of andrology, 4(4), 281–285
Sciorio, R., Angelaki, E., Al-Azemi, N., & Elmardi, A. (2021). One follicle, one egg, one embryo: a case-report of successful pregnancy obtained from a single oocyte collected. JBRA assisted reproduction, 25(2), 314–317. https://doi.org/10.5935/1518-0557.20200087
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