Intracytoplasmic Sperm Injection (ICSI) is used for treatment of severe forms of male infertility. This procedure is carried out by inverted microscope with micromanipulators by using special microinstuments.
Recommendations for ICSI.
- azoospermia – absence of spermatozoa in ejaculate; oligozoospermia – concentration of spermatozoa less than 2 mln/ml; asthenozoospermia – less than 1 mln of active spermatozoa in 1ml; theratozoospermia – less than 5% of normal forms according to the data of Kruger morphological analysis; sperm pathology);
-clinical significant presence of antispermal antibodies in the ejaculate (MAR-test more than 50%);
- unsatisfactory oocytes in vitro fertilization in previous extracorporeal fertilization attempt or its absence.
Cells of radiate crown of oocytes are deleted before the procedure of microinjection. Micromanipulation is carried out only on mature oocytes by presence of first polar body. Methodic of ejaculate or aspirate processing is chosen by embryologist individually depending on the number and quality of spermatozoa.
Main stages of ICSI procedure:
- spermatozoon immobilization by damaging integrity of tail membrane;
- damaging integrity of external cytoplasmic membrane of an oocyte;
- injection of a spermatozoid in the oocytes cytoplasm by using glass microneedle.
Receipt of a spermatozoon for ICSI can be carried out from ejaculate or by surgical methods.
Surgical methods to receive spermatozoa.
Choice of optimal method to receive spermatozoa is made by an andrologist after additional examination.
Spermatozoa for injection to the ovule by azoospermia can be received by using open testicle biopsy with subsequent spermatozoa extraction or aspiration of epididymis contents, as well as by using aspirational operational procedures on epididymis or on testicle.
Operation is usually carried out on the day of follicles puncture. However, we know, that spermatozoa from the epididymis keep the ability of fertilization during 12-24 hours, while testicular spermatozoa keep this ability during 48-72 hours, which allows varying the time of both procedures in certain cases. The use of crioconcervated tissue and testicle aspirate by written announcement of both patients – in this case the procedure of spermatozoa receipt is carried out in advance, independent of follicles puncture.
Recommendations for surgical receipt of spermatozoa are following:
- obstructive azoospermia;
- primary testicular insufficiency.
Contraindications for surgical receipt of spermatozoa are acute infectious diseases of any localization.
The capacity of examination before surgical intervention for receipt of spermatozoa includes:
- defining group of blood and Rhesus factor;
- clinical blood test including time of coagulability (valid for 1 month);
- blood test on syphilis, HIV, hepatitis B and C (valid for 1 month).
Complications by surgical receipt of spermatozoa:
- Scrotum haematomas or intratesticular haematomas;
- infection of operational wound.