Many couples can not have children by natural means. If the cause is a man’s fertility disorder, ICSI (Intracytoplasmic Sperm Injection) is the only chance for a biological child.
What is ICSI?
The abbreviation ICSI stands for “intracytoplasmic sperm injection” and is the most commonly used method of artificial insemination. In the process, a single spermatozoon is injected directly into the cell interior (cytoplasm) of the previously extracted egg using a fine pipette. Fertilization is thus imitated artificially under the microscope. If the fertilized egg then continues to develop, it will be inserted into the uterus in the hope that it will produce one embryo or multiple embryos.
This so-called micro – insemination is used when insufficient fertile sperm are present or the sperm are too lazy to penetrate into the egg by itself.
ICSI: How is the treatment going?
First, the sperm of the man is scrutinized to see how many sperm cells are present. Here is checked how flexible the sperm are, what shape they have and whether infections are present. If too few spermatozoa are present in the ejaculate, sperm cells can also be taken directly from the testicular tissue.
2. Ovulation and egg retrieval
Before the ICSI, hormonal stimulation of the ovaries (ovarian stimulation) is necessary. For this purpose, different methods are used with different hormone preparations. Regular ultrasound examinations and blood tests are then used to check if and how many follicles have formed in the ovaries. When enough is available, ovulation is triggered by a hormone injection. About two to twelve days later, approximately 10-12 oocytes are removed from the vagina under light general anesthesia using an ultrasound probe and a thin needle.
From the sperm collected, individual spermatozoa are selected and injected under the microscope into an egg cell. Per ovum, one sperm.
Unfortunately, this does not mean that every fertilized egg cell evolves. Therefore, more oocytes are fertilized than used later.
If the fertilization has worked out, the resulting embryos are transferred to the uterus two to three days later . The procedure is painless and therefore takes place without anesthesia. In most cases, two fertilized eggs are used per ISCI trial to increase the chance of pregnancy. After 14 days then hopefully the pregnancy test shows that it worked and you are pregnant.
What requirements must be met for an ICSI?
- The woman must be between 25 and 40 years, the man between 25 and 50 years old
- Both must be married or live together in a stable partnership (the statutory health insurance only pays part of the costs for married couples)
- In addition, both partners must have a negative HIV test
- An ICSI is usually performed when treatment with IVF was unsuccessful or it has already become clear from the preliminary examinations that the chances of having a child through in-vitro fertilization are low
- It is certified by a doctor that the treatment has sufficient chances of success
How big are the chances of success of an ICSI?
The success rate of having an ICSI to become pregnant is 20 percent. For if the method ultimately succeeds, is an interplay of many factors . In addition to the age of the woman, her state of health and physical fitness (weight, nutrition, medication, exercise, smoking and alcohol consumption), the quality of the germ cells is the key factor. For example, chromosomal abnormalities may be the reason why the fertilized egg simply does not divide, does not nest in the uterus and is rejected by the body.
What happens to the excess germ cells?
At the first treatment more oocytes are often taken than later fertilized. These eggs and sperm are frozen with the appropriate consent in liquid nitrogen . This has the advantage that no further hormone stimulation is necessary for another attempt , which is particularly stressful for most women.
ICSI or IVF – what’s the difference?
Both procedures are very similar : the hormonal stimulation, the removal of the mature oocytes and the subsequent insertion of the embryos into the uterus are the same in both procedures. Only in the fertilization method differ IVF and ICSI. In vitro fertilization (IVF) brings together male and female germ cells in a Petri dish. However, the sperm must penetrate into the egg shell itself, thus creating it on its own power to fertilize the eggs. The ICSI is helped here and the sperm is sprayed directly into the egg using a syringe.
ICSI has in the meantime overtaken IVF in Germany and is the method used far more frequently . Even women who have had no success with IVF can help ICSI to become pregnant.
For whom is ICSI suitable?
- For couples in whom male fertility is impaired , for example due to closure of the spermatic pathways, sperm cell formation itself is disturbed, sperm antibodies are present in the seminal fluid that complicate procreation, or frozen sperm due to cancer are used should
- The ICSI can also help if the cause of the unfulfilled desire for children can not be clarified (idiopathic sterility) or
- if both partners have a fertility disorder. Sometimes ICSI is a good method of artificial insemination in older couples.
Opportunities and risks of ICSI and IVF
- The intake of hormones to stimulate the ovaries can be very stressful .
- In rare cases, stimulation of the ovaries leads to a so-called hyperstimulation syndrome , in which the woman’s body “overreacts” to the hormone preparations. Symptoms include abdominal pain, nausea, tummy tensions and shortness of breath. In this case, the doctor must be notified immediately.
- If multiple embryos are introduced into the uterus, the natural risk of multiple pregnancy (about 20 to 30 percent for IVF and ICSI) and a high-risk pregnancy are increased .
- If pregnancy occurs after an ICSI, it usually proceeds normally, although the risk of miscarriage is slightly increased.
- The psychological burden is often underestimated by couples undergoing fertility treatment, and it puts not only the body, but also the relationship to a hard test.
- At the latest after the second or third failed attempt, it is time to talk about alternatives to fertility medicine . Also care or adoption can be the way to a desired child.
- The average birth rate per treatment cycle is given for the ICSI at 15 to a maximum of 20%.
- The chances of having a child after ICSI treatment are very dependent on the couple’s personal requirements.
- For some disorders of sperm production , the ICSI method has little or no chance of success.
- Fertility of the woman is a decisive factor: some women do not produce egg cells despite hormonal stimulation, in others the eggs do not develop after fertilization or the embryo does not nest in the uterus after transmission.
- The age of the woman plays an important role. The older the woman is, the lower the chance of having a child through an ICSI.
How much does an ICSI cost and what does the health insurance pay?
- An ICSI treatment costs about 4000 euros per experiment .
- If more oocytes were collected than were used for the first trial, there would be costs for the storage (cryopreservation) of the germ cells for future experiments. These amount to 300-500 euros.
The statutory health insurance companies usually pay 50 percent of the costs , but for a maximum of three experiments and under special conditions. Some funds advertise with higher percentages, here should be weighed individually. The amount of the rate taken over by private health insurances is also different.
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