Intracytoplasmic Sperm Injection (ICSI) with DrMohamed Mamdouh Thabet

ICSI (Intracytoplasmic Sperm Injection) as a treatment for infertility and delayed pregnancy. Discover the procedure's steps, success rates, and required medical tests with Dr. Mohamed Mamdouh Thabet, Lecturer and Consultant of Obstetrics and Gynecology at Kasr Al Ainy and Member of the Royal College of Obstetricians and Gynaecologists (RCOG), London.

What Is ICSI?

Intracytoplasmic Sperm Injection (ICSI) is one of the most important assisted reproductive technologies that has helped many couples achieve their dream of having a baby, especially in cases of infertility related to male or female fertility problems.

ICSI involves selecting a single sperm and injecting it directly into an egg using highly specialized instruments under a microscope in an embryology laboratory. The resulting embryos are then monitored, and a suitable embryo is selected for transfer into the woman's uterus.

This technique helps overcome certain problems that may prevent natural fertilization, particularly cases involving poor sperm quality, low sperm count, or other factors affecting fertilization.

A thorough medical evaluation before deciding on ICSI is essential, as the causes of infertility vary from one couple to another. Therefore, the most appropriate treatment approach should be determined based on medical investigations.

When Is ICSI Recommended?

A doctor may recommend ICSI in certain cases of infertility where natural conception or other fertility treatments may not be suitable.

Common indications for ICSI include:

• Low sperm count.
• Poor sperm motility.
• High percentage of abnormal sperm morphology in certain cases.
• Difficulty achieving fertilization.
• Previous unsuccessful artificial insemination or IVF attempts in selected cases.
• Severe male fertility problems.
• The need to use surgically retrieved sperm in certain cases.
• Other medical factors identified after evaluating both partners.

It is important to understand that ICSI is not the appropriate solution for every infertility case. The decision depends on the underlying cause, investigation results, and the couple's medical condition.

What Is the Difference Between ICSI and IVF?

Many people confuse ICSI with IVF. Although both are assisted reproductive techniques involving fertilization outside the body, they differ in how fertilization takes place.

In Vitro Fertilization (IVF):

Several sperm are placed together with the eggs in a laboratory dish, allowing the sperm to fertilize the eggs naturally under controlled laboratory conditions.

Intracytoplasmic Sperm Injection (ICSI):

A single sperm is selected and injected directly into an egg using specialized instruments under a microscope.

The doctor determines the most suitable technique based on semen analysis, egg quality, and the couple's medical history.

Steps of the ICSI Procedure in Detail

The ICSI procedure involves several stages, each requiring careful medical monitoring to ensure proper handling of the eggs and embryos.

1. Medical Investigations Before ICSI

Before starting the procedure, both partners undergo a medical evaluation to identify the causes of infertility and determine whether ICSI is an appropriate option.

Potential investigations include:

For the woman:

• Transvaginal ultrasound to evaluate the uterus and ovaries.
• AMH testing to assess ovarian reserve.
• Hormonal blood tests according to the individual case.
• Assessment of the uterine lining.
• Additional investigations based on medical history.

For the man:

• Semen analysis.
• Evaluation of sperm count, motility, and morphology.
• Hormonal tests in certain cases.
• Additional investigations if there are problems with sperm production.

2. Ovarian Stimulation

This stage involves hormonal medications prescribed by the doctor to stimulate the ovaries to produce multiple eggs instead of the single egg usually released during a natural menstrual cycle.

During this period, the ovaries are monitored through ultrasound examinations and appropriate blood tests. Medication doses may be adjusted according to the ovarian response.

3. Egg Retrieval

Once the eggs have reached the appropriate stage of development, a trigger injection is administered at a specific time.

The eggs are then retrieved from the ovaries using a fine needle under ultrasound guidance, usually with appropriate anesthesia or sedation.

The retrieved eggs are transferred to the embryology laboratory for evaluation and preparation for ICSI.

4. Sperm Preparation

A sperm sample is collected from the husband and processed in the laboratory to select suitable sperm based on their movement and appearance.

In some cases, when sperm are not present in the semen sample, surgical sperm retrieval may be considered following medical evaluation.

5. Injecting the Eggs with Sperm

This is the main stage of the ICSI procedure. An embryologist selects a single sperm and injects it directly into each mature egg using highly specialized instruments under a microscope.

The eggs are then placed in a controlled laboratory environment to monitor fertilization.

6. Embryo Development and Monitoring

After ICSI, the fertilized eggs are monitored in the embryology laboratory to assess cell division and embryo development.

Embryo quality is evaluated according to specialized laboratory criteria, and suitable embryos are selected for transfer into the uterus.

7. Embryo Transfer

The selected embryo or embryos are transferred into the uterus using a thin catheter.

The number of embryos transferred is determined according to the woman's age, medical condition, embryo quality, and medical recommendations, while taking care to reduce the risk of multiple pregnancy.

In some cases, the doctor may recommend freezing the embryos for future use instead of transferring them during the same cycle.

8. Pregnancy Testing After ICSI

Following embryo transfer, the woman waits for the period recommended by the doctor before undergoing a quantitative blood pregnancy test (Beta hCG).

This test helps determine whether pregnancy has occurred. The doctor may recommend repeating the test or performing an ultrasound at the appropriate time to confirm pregnancy development.

What Is the Success Rate of ICSI?

ICSI success rates vary from one case to another, and there is no single success rate that applies to all couples.

Several factors can influence the chances of success, including:

• The woman's age, which is one of the most important factors.
• Ovarian reserve and egg quality.
• Sperm quality.
• The number and quality of embryos.
• The condition of the uterine lining.
• The underlying cause of infertility.
• Previous ICSI treatment history.
• The quality of the embryology laboratory and the experience of the medical team.

Success rates are generally higher among younger women, particularly when using their own eggs. Chances may decrease with advancing age due to changes in egg quality.

What Are the Reasons for ICSI Failure?

An ICSI cycle may not be successful on the first attempt. However, this does not necessarily mean that pregnancy will be impossible in future attempts.

Possible reasons for unsuccessful ICSI include:

• Poor egg quality.
• Problems with sperm quality.
• Failure of fertilization.
• Early embryo development arrest.
• Failure of embryo implantation in the uterine lining.
• Certain uterine or endometrial conditions.
• Age-related changes.
• Certain genetic or chromosomal factors.

If an attempt is unsuccessful, the doctor needs to review the previous treatment cycle, embryology laboratory results, and medical investigations to determine whether the treatment plan should be adjusted.

Is the ICSI Procedure Painful?

The level of discomfort varies depending on the stage of treatment.

• Ovarian stimulation: The woman may experience mild bloating or pelvic heaviness.
• Egg retrieval: Usually performed under appropriate anesthesia or sedation. Mild cramping may occur afterward.
• Embryo transfer: Generally a simple procedure that does not require anesthesia.
• After embryo transfer: Mild cramps may occur. However, severe pain, bleeding, or significant abdominal swelling should be reported to the doctor.

Important Tips Before and After ICSI

Certain recommendations can help couples prepare for the procedure and maintain their health throughout treatment.

Before ICSI:

• Complete all required medical investigations.
• Follow the doctor's instructions and medication schedule.
• Maintain a healthy body weight whenever possible.
• Follow a balanced diet.
• Stop smoking.
• Avoid taking medications without medical advice.
• Get enough sleep and rest.

After embryo transfer:

• Continue taking all prescribed medications.
• Avoid strenuous physical activity.
• Resume normal light daily activities according to medical advice.
• Never stop prescribed medications without consulting the doctor.
• Perform the pregnancy test on the scheduled date.
• Do not rely on symptoms alone to determine whether the procedure was successful.

Is Complete Bed Rest Necessary After ICSI?

Not all women need complete bed rest or prolonged periods of lying in bed after embryo transfer. There is no proven benefit to extended bed rest following embryo transfer.

Women can generally return to light daily activities according to their doctor's instructions, while avoiding strenuous physical activity and following individual medical recommendations.

When Do Signs of Successful ICSI Appear?

Some women may experience symptoms after embryo transfer, such as:

• Mild abdominal cramps.
• Bloating.
• Breast tenderness.
• Fatigue.
• Light vaginal discharge.

However, these symptoms do not confirm successful ICSI, as they may also be related to the hormonal medications used during treatment.

A quantitative blood pregnancy test, performed at the time recommended by the doctor, remains the appropriate way to assess whether pregnancy has occurred.

Infertility Treatment and ICSI with Dr. Mohamed Mamdouh Thabet

If you are looking for a specialist in obstetrics and gynecology to evaluate the causes of delayed pregnancy, you can consult Dr. Mohamed Mamdouh Thabet, Lecturer and Consultant of Obstetrics and Gynecology at Kasr Al Ainy and Member of the Royal College of Obstetricians and Gynaecologists (RCOG), London.

The journey toward treating infertility begins with an accurate diagnosis and a comprehensive evaluation of both partners, followed by identifying the most appropriate treatment options according to the underlying cause of delayed pregnancy.

Choosing the right treatment approach is one of the most important steps in improving the chances of conception, whether through treating ovulation disorders, addressing fertility-related problems, or evaluating the need for assisted reproductive technologies.