| Intra Cytoplasmic Sperm Injection (ICSI) |
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ICSI is a procedure used for the treatment of male factor infertility. It involves the injection of a single live sperm directly into the egg using a very fine glass needle under high power microscope.
In standard IVF, eggs and sperm are mixed together in a Petri herefore employed to circumvent the problem of poor sperm penetration.
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Indications for ICSI:
- Low sperm count and motility.
- Antisperm antibodies.
- Previous failure of fertilisation in conventional IVF.
- Retrograde ejaculation where sperm is retrieved from urine.
- Absence or blockage of the vas deferens (congenital or acquired through vasectomy/disease process).
- Early testicular failure.
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Following ICSI, on average approximately 60% of the eggs will fertilise regardless of the quality of the sperm. Prior to ICSI, the only option for severe male factor infertility was the use of donor sperm. ICSI therefore offers couples the real benefit of having genetically related children.
ICSI is purely a laboratory procedure. Therefore, ovarian stimulation, cycle monitoring, egg collection and embryo transfer are the same as for conventional IVF. The sperm sample is prepared on the day of egg collection. The embryologist selects a single live sperm and injects it directly into a healthy and mature egg. The injected eggs are examined on the next day for evidence of fertilisation. The best one or two embryos are transferred into the uterus on day 2-3 or cultured further until day 5 (blastocyst transfer). Any suitable remaining embryos can be frozen, with your consent.
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PESA (Percutaneous Epididymal Sperm Aspiration)
In cases of mechanical blockage of the vas deferens, either congenital or acquired as the result of vasectomy or some disease process, sperm produced by the testis cannot be released and remain stored in the epididymis.
The trapped sperm can be removed surgically by PESA. In this procedure a fine needle is inserted through the skin of the scrotum to aspirate the sperm from the epididymis.
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TESE (Testicular Sperm Extraction)
TESE is performed when PESA is unsuccessful, and in men suffering from early signs of testicular failure where no sperm is likely to be present in the epididymis. In this procedure a small incision is made in the scrotum and testis and a biopsy of testicular tissue is taken from which sperm is extracted in the laboratory.
Unfortunately, in a small number of cases we may be unsuccessful in retrieving sperm, and the option is then to either abandon egg recovery or use preplanned donor sperm.
PESA and TESE are carried out under deep sedation with or without local anaesthetic and are normally performed prior to the female partner’s planned egg recovery.
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