Intracytoplasmic sperm injection is a special method of IVF treatment. For couples in which the man has an extreme reduction in the quality of sperm, it is assumed that fertilisation by means of the normal conventional IVF method will no longer lead to success. Therefore, the ICSI method is recommended for these couples. Treatment with ICSI can also become necessary if no fertilisation has occurred with normal IVF treatment.
ICSI treatment is recommended in the case of:
- Significantly reduced sperm quality
- Absence of fertilisation during in-vitro fertilisation
Before the start of ICSI treatment, it is recommended that both partners undergo genetic counselling and chromosome analysis. The reason for this recommendation is that chromosome anomalies are statistically more common in couples who desire to have children. The chromosome analysis is completed through a blood sample; the result is available in about four weeks.
The success rates of ICSI treatment are good, even in the event of very poor sperm quality and sperm numbers and are comparable with those of conventional IVF treatment. The presence of a few sperm cells is usually sufficient for ICSI treatment. The pregnancy rates per cycle are about 20 to 30 percent.
With the ICSI method, excess fertilised ova in the pro-nuclear stage can also be deep-frozen upon request and are available for a later embryo transfer.
ICSI – Procedure
For the couple, the treatment procedure remains the same as during IVF treatment. The ovarian stimulation treatment, the ovum collection, and the embryo transfer take place in exactly the same way in ICSI as they do in IVF. The difference to conventional IVF consists only in an additional work step in the laboratory and concerns the handling of the ovum and sperm cells. The sperm extraction usually takes place through masturbation on the same day as the ovum collection. As a general rule, it is also possible to obtain sperm from the testicles (TESE), if no sperm are found in the man’s ejaculate (semen sample).
In the ICSI method, after the ovum collection (punction) the sperm is not added to the ova in the culture dish, as it is in the conventional IVF method. However, one sperm is brought directly into the ovum with the aid of a very fine, hollow, glass needle under a microscope. This method can be applied for all mature ovum cells that are obtained. For the injection, a sperm is required. This sperm does not necessarily need to be motile. Sperm that are conspicuous in their appearance can also be used successfully. Therefore, the ovum fertilisation rate is significantly increased when the ICSI method is used.
The transfer of the fertilised ova into the womb (embryo transfer) generally takes place 2-3 days after ovum collection. The implantation phase starts in the following two weeks and is supported by the administration of a corpus luteum hormone. Two weeks after the embryo transfer, a pregnancy test is carried out. Couples can complete the test on site at the Fertility Centre. For this, blood is taken and the hCG value (pregnancy hormone) is determined. The test result is generally available on the same day. Of course, you can also complete the pregnancy test with your own gynaecologist.
ICSI – costs
In Germany, the statutory health insurance companies must only meet the costs of artificial insemination through ICSI if certain threshold values are met. Independently of this, both the advisory consultation and also a majority of the diagnostics are performed in advance without any cost to the patients.
The statutory health insurance companies in Germany currently approve three ICSI attempts and assume half of the costs per attempt. However, this only applies to married couples. The wife and husband must have reached the age of 25 years before the start of treatment. The woman must not have reached the age of 40, nor the man the age of 50, before the start of treatment. Additionally, two spermiograms, taken 12 weeks apart, must be present. These must meet specific criteria. An examination by an andrologist must also take place. At the Fertility Centre, we can help you to asses the assumption of costs by the statutory health insurance companies.
There is the option of completing a spermiogram in the Fertility Centre. Suitable rooms, in a quiet and private environment, are available. The result of the spermiogram will be available the following day and can be given to the couple in various ways. For example, in a personal consultation, by phone, e-mail, SMS, or postal mail.
A spermiogram can also be completed by a urologist. The result should be submitted to the Fertility Centre, so that the next steps in treatment can be discussed with the couple in a private advisory consultation.
For couples with private or mixed insurance (one partner with statutory insurance and the other with private insurance) other rules apply with regards to the assumption of costs.
For these couples, we will of course gladly help with questions and in organising the assumption of costs.
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