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ICSI - Intracitoplasmic Sperm Injection

ICSI - Intracitoplasmic Sperm Injection
The intracitoplasmic sperm injection (ICSI) is the injection of a single sperm within the oocyte, thus giving rise to an embryo. Once formed, the embryo is transferred into the womb following a process similar to that used in IVF.

Oocytes are collected from the ovaries and fertilized in the laboratory . ICSI is usually advised in cases of severe oligozoospermia (men with a very low number of spermatozoa) or absence of fertilization in previous attempts of conventional IVF. To perform an ICSI, only one sperm per egg is required, whereas in classic IVF between 50,000 and 100,000 spermatozoa are required. Once obtained, the embryos are transferred to the woman's uterus for implant and potential pregnancy.

ICSI is recommended in situations of spermogram alterations (number, motility and/or morphological characteristics of spermatozoa); high concentrations of anti-sperm antibodies; history of poor fertilisation in conventional IVF attempts; use of frozen Sperm; ejaculation disorders (eg. retrograde ejaculation); and use of testicular or epididymal spermatozoa (surgically retrieved sperm). ICSI is also particularly useful in situations where for any pathological reason the spermatozoon cannot penetrate the oocyte and also when the spermatozoa have abnormal shapes. In cases of women with diminished ovarian reserve, in which the number of oocytes obtained is equal to or less than 4 it may also be preferable to perform ICSI rather than traditional IVF, since the total or partial failure of fertilisation in conventional IVF could put the treatment at risk.

Stages of the treatment

  • 1. Ovarian Stimulation and Control

    After the first medical appointment, the woman begins to be treated with ovulation-stimulating drugs, administered by subcutaneous injections. These drugs (similar to hormones that are naturally produced in women) will stimulate the ovaries to produce more oocytes than usual.

    The development of oocytes is then controlled by periodic ultrasound examinations and blood tests (to assess levels of specific  hormones).

    When the doctor considers that the follicles are sufficiently developed, they prescribe the injection of another hormone (human chorionic gonadotropin - hCG), whose role is to trigger the release of the oocytes from the ovarian follicles.

    At this stage timing has a key role: the oocyte pick-up (retrieving oocytes from the ovaries) should be made 35 to 36 hours after the hCG administration. It is very important that couples adhere strictly to the timings indicated by the gynaecologist for the administration of the injections as a mistake at this stage could  jeopardise the whole treatment process.


    At Ferticentro we take special care with this phase of the process - our clinical team is in constant touch with patients for 24 hours to ensure that all medicines are administered correctly and patients are reassured throughout the process. 



    2. Oocyte pickup

    The oocyte pick-up is carried out under ultrasound monitoring and involves the introduction into the vagina of a very fine needle that will allow the collection of oocytes from each of the ovaries. This operation is performed under sedation and takes about 15 minutes. From the day of the egg retrieval, the woman starts taking 2 tablets of progesterone every 8 hours, in order to prepare the endometrium for a successful embryo implantation.

    On the same day as the oocyte retrieval, the man will be asked to collect sperm in the clinic, so that it can be used in the treatment (although the use of frozen sperm is also possible). Once obtained, the sperm is centrifuged at high speed and subjected to a series of treatment processes in order to select the strongest and more viable spermatozoa.

    In situations where it is not possible to produce sperm by masturbation, it may be necessary to perform a testicular biopsy to collect sperm directly from the testicles.

    After the oocyte pick-up, the oocytes are treated and transferred to special culture media in the laboratory. Later, each viable and mature oocyte will be microinjected with a single spermatozoon. After this process, the microinjected oocytes are transferred once again into another culture medium to encourage  the formation of embryos.

    The following day, our embryologists will call you to inform you of the results of fertilisation and also to talk about scheduling the embryo transfer.



    3. Embryo Transfer

    On the Embryo transfer day (two to five days after fertilization) the embryos (usually two) are transferred into the womb of the woman for implantation and potential pregnancy.

    In cases where there are several good quality embryos to transfer or when further embryo analysis is required the transfer may be made on the fifth day. At Ferticentro this extended embryo culture has no additional costs for the couple as  it is a technical decision based on the individual case. It is recommended to avoid intense physical activity for 5 days after embryo transfer. Women can travel by car or plane after embryo transfer but we recommend they avoid physical activity such as heavy lifting.  This type of precaution is advised in the interest of best practice rather than based on any scientific evidence – we encourage all our patients to take some time out to encourage nature to do its work.



    4. Embryo Cryopreservation

    Any viable surplus embryos that are not used during the fresh treatment can be frozen and used later in a subsequent frozen transfer cycle (either because the couple wants to have a second child, or if the first attempt fails); can be donated for scientific research; can be donated to another couple or may be destroyed, depending on the couple's decision and the conditions laid down by law.

    The pregnancy test should be done 2 weeks after embryo transfer. We advise all women to have a blood pregnancy test as a preferred alternative to using urinary markers. A blood test will be more accurate and provide relevant information regarding the treatment.

Treatment cost

To find out more about treatment costs, please fill our contact form.

More information

  • Like any medical treatment, ICSI can cause adverse reactions. Whilst receiving treatment at Ferticentro all couples are closely monitored by the attending physician (who will always be contactable via mobile phone) and all procedures are performed in accordance with the strictest international safety standards, it is important that couples are aware that less pleasant situations can exist and that these, although rare, are also part of the practice of medicine.

    Adverse reactions to drugs used in ICSI cycles are rare and are generally moderate and transient. The most common are hot flushes, irritability, fatigue and headaches. These usually pass after a short time and are not a cause for alarm. In case of worsening or persistent symptoms, we recommend that you contact your Ferticentro physician accompanying your treatment. In some rare cases (less than 1% ) Ovarian Hyperstimulation Syndrome, which is an excessive and potentially dangerous reaction to the drugs used in ovarian stimulation, can occur. In these situations there is accumulation of fluid and formation of cysts in the ovaries. The main symptoms are: pelvic and / or abdominal pain, nausea, vomiting and shortness of breath. This is a serious reaction, which should be immediately reported to the attending physician. In more severe cases, treatment may be interrupted or hospitalisation may be required. If Ovarian Hyperstimulation Syndrome occurs after the oocyte pick-up, we do not make the transfer and freeze all the embryos that were obtained so that their subsequent use is possible. It is also possible to freeze all the oocytes obtained, with excellent survival rates.

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