( 15 JAN 2016 )

As the number of couples battling infertility issues is on the rise, there have been corresponding advances in medical techniques to combat these problems. In the best interest of the patient, fertility specialists consider an array of factors to determine which treatmentmethod would be most effective for a particular couple.

At the same time, patients need to be aware why their fertility doctor has recommended a particular treatment. Specialists at Shantah fertility centre believe that a well-informed patient is easier to treat, and therefore, they ensure that the patient is well aware of the reasons why a particular treatment has been offered to them from a set of available options.
In this blog post, we discuss how your doctor determines whether you need IVF or its advanced form, ICSI.
ICSI,a modified form of the standard IVF treatment, is generally employed in cases of severe male infertility. To understand whether ICSI would be a better option for them over IVF, a couple must first understand the difference between the two.

IVF or in vitro fertilization is the standard procedure in which the female oocyte (egg) is made to fertilize with male sperm in the laboratory. The embryo so formed is placed in the woman’s uterus for implantation.
In most cases, multiple oocytes are fertilized in a cycle to increase the success rate of the procedure. The entire cycle spans a period of 4-6 weeks, starting with the stimulation of the ovaries to promote oocyte growth, followed by retrieval of the matured eggs. Correspondingly, sperms are harvested from the male, and both are fertilized in a lab dish on a selective basis. This is followed by 2-5 days of embryo culture (allowing the embryo to develop), after which the embryo is transferred to the uterus. In case there are multiple embryos, the remaining ones may be preserved for future use.
From the first step to the last, continuous monitoring by experts is required to maximize the chances of success of the procedure.

ICSI or Intracytoplasmic Sperm Injectionis a procedure which takes IVF one step ahead. During ICSI, instead of leaving the oocyte with sperm in the lab dish, a single, selected sperm is directly injected into a mature oocyte.
The procedure requires an expert embryologist who separates high quality spermfrom the available sample and preparesthemfor insemination. A great deal of technical expertise is required for the procedure as it involves the delicate task of injecting the sperm into the cytoplasm of the oocyte under microscopic vision. Here, the sperm can come either from a fresh sample collected on the day of the procedure; collected through a simple surgical procedure if the male cannot provide a semen sample; or donor sperm may be used, if there are severe male infertility issues. Once fertilization occurs, the rest of the procedure is carried out in a manner similar to IVF.

There is no medical standard for the cases where ICSI must be used and the success rates of both the procedures are almost similar. Most couples facing severe male infertility are recommended ICSI as the treatment option. This is useful because men with poor sperm count may have very few numbers of motile (viable)sperm, so your doctor’s intention is to make the best use of the available healthy sperm.

[Learn more about male factor infertility]
If your fertility clinic has recommended ICSI over IVF, they need to be able to explain to you why they believe it may be of benefit in your case.
To help you understand, here are some situations where ICSI is rightly recommended for couples:
• There is severe male factor infertility, yet the couple would not prefer donor sperm insemination
• Low sperm count (less than 15-20 million per mm) and low motility (less than 35%)
• History of failed IVF where there has been no fertilization or low rate of fertilization
• Women yielding fewer eggs on egg retrieval would benefit from ICSI because it gives then higher chances of fertilization of eggs.
Your doctor may suggest ICSI if they believe it can increase the likelihood of successful conception in the first attempt. A credible and transparent fertility clinic would help you make an informed decision on whether you should choose the needle over the dish.
Shantah Fertility Centre is a leading fertility clinic with high success rates in the most complex fertility procedures including IVF and ICSI.
Patients looking for expert answers to questions related to the selection of the right assisted reproductive technique or those seeking alternativeexpert advicemay contact for a free second opinion.