Until the 90's males with very low counts(less than 5million per ml) or poor quality sperms had no hope of fathering children, This problem was surmounted by the new breakthrough of ICSI, which took place in Brussels, Belgium in 1992.
Since then, many such patients have fathered a child. In ICSI all the steps are similar to the procedure of IVF, except the step of fertilization. Normally in IVF one egg is mixed with 100,000 sperms and one of the sperms fertilizes the egg on its own, In contrast, in ICSI each egg is held and injected with a single live sperm, This micro-fertilization is done with the help of a machine called the Micromanipulator. ICSI is done where egg is held and injected with single live sperm, cultured for 2-3 days and good quality of embryos are transffered in the uterus.
Indications for ICSI is a technique usually performed in males with:
Where there is no sperm present in the semen. The azoospermia may be of obstructive type where there is production of sperms in the testis but blockage of the conduction system, which brings the sperm out into the semen. Alternately, the azoospermia may be of the non-obstructive type, where there is a failure of the testis to produce sperms. Now a days, in both these types of azoospermia, sperms can be isolated directly from the testis, using the sperm retrieval Techniques of PESA/TESA /TESE and subsequently, ICSI can be performed on:
In our unit we also believe in doing ICSI on patients who have had previous history of tuberculosis or endometriosis, as we believe it gives better fertilization rates than standard IVF. Now-a-days, some units are advocating routine ICSI for all patients, including those with normal sperm counts. We do not believe in such practice as wel feel that prenancy should be achieved with minimum handling of the gametes outside the body. If the sperm count, which is in the grey-one area, then we may subject half the eggs to IVF and half the eggs to ICSI. Our success rates are in the region of 35 to 40% in both azoospermia and non-azoospermia patients, which are comparable to the best in the world.