Intracytoplasmic Sperm Injection
Rather than an oocyte being added to a droplet containing many sperm as in standard in vitro fertilisation, each oocyte is injected with a single immobilised sperm by means of a very fine glass needle inserted into the oocytes with a micro-manipulator. ICSI is the method of choice when the number or quality of sperm available is low and a pregnancy has not occurred by natural means. It’s also used when fertilisation of oocytes have failed to occur in a previous attempt with standard IVF or for men with no sperm in the ejaculate but who have motile sperm which can be collected surgically.
There have been some concerns specifically related to ICSI. ICSI has only been available since 1993, therefore follow up of ICSI conceived children has been limited. Current studies suggest that there is an increased risk of congenital abnormalities in children conceived by ICSI of 1-2% above the background risk (3-4%) i.e. 5-6% although this is probably related to the cause of infertility rather than ICSI itself.
It has been reported that approximately 15% of men with zero or very low sperm counts have a deficiency of genes on their Y chromosome (micro deletion). This condition may be passed on to male offspring. A blood test is available to ensure the chromosome number is normal (covered by Medicare) and another test to identify the micro deletion cause of infertility. Y chromosome deletion testing is available, however it is currently not covered by medicare and will incur an additional cost.