Fertilization involves a complex series of physical and biochemical events, which take place between the egg and sperm. Though IVF places sperm and eggs together, a sperm must still be able to penetrate the egg for fertilization to occure. To do this, the sperm must be able to secrete enzymes to enable it to move through the cumulus mass which surrounds the egg. It then must attach to and drill through the protein coat (zona pellucida) which protects the egg, and to attach to the egg membrane. The egg must be able to engulf the sperm and to cause the sperm head to swell and become a male pronucleus. This will then combine with the female pronucleus to complete the process of fertilization. The failure of any one of these processes results in no fertilization.

In our on-site lab, we perform advanced micromanipulation techniques, utilizing extremely fine needles, pipettes and microscopy. With ICSI, a single sperm is injected into the egg to allow for fertilization. Oocytes are retrieved using standard IVF stimulation and recovery techniques. Mature oocytes are carefully held with a pipette, and under microscopic guidance, a fine glass needle is used to inject a single sperm into the egg itself. The oocytes will then be cultured and observed for fertilization and cleavage as in any IVF cycle. Depending on the number of cleaved embryos available, some or all will be transferred to the uterus 72 hours after oocyte retrieval. Extra embryos may be frozen.

Indications for Intracytoplasmic Sperm Injection

• Very low numbers of motile sperm.
• Severe teratospermia (abnormal shapes)
• Problems with sperm binding to and penetrating the egg.
• Antisperm antibodies thought to be the cause of infertility.
• Prior or repeated fertilization failure with standard IVF methods.
• Frozen sperm limited in number and quality.
• Obstruction of the male reproductive tract not amenable to repair. Sperm may then be obtained from the epi-didymis by a procedure called microsurgical epididymal sperm aspiration (MESA), or from the testes by tes-ticular sperm aspiration (TESA).

Qick Time Clip of ICSI proceedure

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A single sperm is injected from the needle on the right.