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* Gordon, Ian R. Laboratory production of cattle embryos/I. Gordon. -- 2nd ed. 2003 {{ISBN|0-85199-666-3}}
* Gordon, Ian R. Laboratory production of cattle embryos/I. Gordon. -- 2nd ed. 2003 {{ISBN|0-85199-666-3}}
==External links==
==External links==
* [http://www.hfea.gov.uk/ The Human Fertilisation and Embryology Authority (HFEA)]
* [https://web.archive.org/web/19981111191342/http://www.hfea.gov.uk/ The Human Fertilisation and Embryology Authority (HFEA)]
* [http://www.epigenome-noe.net/ The Epigenome Network of Excellence (NoE)]
* [http://www.epigenome-noe.net/ The Epigenome Network of Excellence (NoE)]
* [http://www.testtubebabyprocess.com/2016/12/icsi-ivf.html TEST TUBE BABY PROCESS ]
* [http://www.testtubebabyprocess.com/2016/12/icsi-ivf.html TEST TUBE BABY PROCESS ]

Revision as of 17:14, 27 July 2017

Intracytoplasmic sperm injection
Oocyte is injected during ICSI
MeSHD020554

Intracytoplasmic sperm injection (ICSI, pronounced /ɪksiː/, IK-see) is an in vitro fertilization (IVF) procedure in which a single sperm is injected directly into an egg. Defective sperm function remains the single most important cause of human infertility.[1] Although certain severe forms of male infertility have a genetic origin, others may be the result of environmental factors. During the past decade, ICSI has been applied increasingly around the world to alleviate problems of severe male infertility in human patients who either could not be assisted by conventional IVF procedures or could not be accepted for IVF because too few motile and morphologically normal sperm were present in the ejaculate of the male partner.[2]

Indications

Schematic image of intracytoplasmic sperm injection in the context of IVF.

This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally in addition to sperm donation.[3]

It can be used in teratozoospermia, because once the egg is fertilized, abnormal sperm morphology does not appear to influence blastocyst development or blastocyst morphology.[4] Even with severe teratozoospermia, microscopy can still detect the few sperm cells that have a "normal" morphology, allowing for optimal success rate.[4]

History

The first child born from a gamete micromanipulation (technique in which special tools and inverted microscopes are used that help embryologists to choose and pick an individual sperm for ICSI IVF) was a child in Singapore-born in April 1989.[5]

The technique was developed by Gianpiero Palermo at the Vrije Universiteit Brussel, in the Center for Reproductive Medicine headed by Paul Devroey and Andre Van Steirteghem.[6]

The procedure itself was first performed in 1987,[7] though it only went to the pronuclear stage.[8] The first activated embryo by ICSI was produced in 1990,[9] but the first successful birth by ICSI took place on January 14, 1992 after an April 1991[10] conception.[11]

Laboratory equipment

There are some requirements that an IVF lab need to correctly perform ICSI technique. There are basically 5 main elements: laminar flow cabinet, inverted microscope, micromanipulators, microinjectors and anti-vibration table.

  • Laminar flow cabinet. It has to contain a hot surface and an environment with 5% of CO2.
  • Inverted microscope. It should have 20X and 40X lens, with Hoffman optics, and a 37 °C surface to have an optimal maintenance of the biological material.
  • Micromanipulators. They allow us to move in three dimensions, so that there will be one on the left to control the holding of the micropipette and another to the right for the injection micropipette. In addition, there is an electric manipulator for large movements and an hydraulic one for the finest (adjustment of the pipettes is done with the hydraulic and quick movements to place them with the electric).
  • Microinjectors. They are hermetic syringes filled with mineral oil controlled by the micromanipulators and connected to the microinjection pipettes (to aspirate and inject the spermatozoa) by a flexible tube.
  • Anti-vibration table. It has to contain hydrogen to assure the optimal work conditions.[12]

Procedure

ICSI is generally performed following a transvaginal oocyte retrieval procedure to extract one to several oocytes from a woman.

In ICSI IVF, the male partner or a donor needs to provide a sperm sample on the same day when your eggs are collected.[13] The sample will be checked in the lab, and If there is no sperm in his semen, doctors will extract sperm from epididymis or testicle. The extraction of sperm from epididymis is also known as percutaneous epididymal sperm aspiration (PESA) and extraction of sperm from testicle is also known as testicular sperm aspiration (TESA).

The procedure is done under a microscope using multiple micromanipulation devices (micromanipulator, microinjectors and micropipettes). A holding pipette stabilizes the mature oocyte with gentle suction applied by a microinjector. From the opposite side a thin, hollow glass micropipette is used to collect a single sperm, having immobilised it by cutting its tail with the point of the micropipette. The oocyte is pierced through the oolemma and directed to the inner part of the oocyte (cytoplasm). The sperm is then released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o'clock indicating its maturity. The polar body is positioned at the 12 or 6 o'clock position, to ensure that the inserted micropipette does not disrupt the spindle inside the egg. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.

In contrast, in natural fertilization sperm compete and when the first sperm penetrates the oolemma, the oolemma hardens to block the entry of any other sperm. Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without any specific testing. However, in mid-2006 the FDA cleared a device that allows embryologists to select mature sperm for ICSI based on sperm binding to hyaluronan, the main constituent of the gel layer (cumulus oophorus) surrounding the oocyte. The device provides microscopic droplets of hyaluronan hydrogel attached to the culture dish. The embryologist places the prepared sperm on the microdot, selects and captures sperm that bind to the dot. Basic research on the maturation of sperm shows that hyaluronan-binding sperm are more mature and show fewer DNA strand breaks and significantly lower levels of aneuploidy than the sperm population from which they were selected. A brand name for one such sperm selection device is PICSI.[14] A recent clinical trial showed a sharp reduction in miscarriage with embryos derived from PICSI sperm selection.[15]

'Washed' or 'unwashed' sperm may be used in the process.

Live birth rate are significantly higher with progesterone to assist implantation in ICSI cycles.[16] Also, addition of a GNRH agonist has been estimated to increase success rates.[16][17]

Ultra-high magnification sperm injection (IMSI) has no evidence of increased live birth or miscarriage rates compared to standard ICSI.[18]

Success or failure factors

One of the areas in which sperm injection can be useful is vasectomy reversal. However, potential factors that may influence pregnancy rates (and live birth rates) in ICSI include level of DNA fragmentation[19] as measured e.g. by comet assay, advanced maternal age and semen quality.

Complications

There is some suggestion that birth defects are increased with the use of IVF in general, and ICSI specifically, though different studies show contradictory results. In a summary position paper, the Practice Committee of the American Society of Reproductive Medicine has said it considers ICSI safe and effective therapy for male factor infertility, but may carry an increased risk for the transmission of selected genetic abnormalities to offspring, either through the procedure itself or through the increased inherent risk of such abnormalities in parents undergoing the procedure.[20]

An online news story on MSNBC.com by Marilynn Marchione of the Associated Press, released on Saturday, May 5, 2012, discussed the risk of birth defects in ICSI versus natural conception or normal IVF; the following is a directly quoted segment of that release:

"Test-tube babies have higher rates of birth defects, and doctors have long wondered: Is it because of certain fertility treatments or infertility itself? A large new study from Australia suggests both may play a role.

Compared to those conceived naturally, babies that resulted from simple IVF, or in vitro fertilization—mixing eggs and sperm in a lab dish—had no greater risk of birth defects once factors such as the mother's age and smoking were taken into account.

However, birth defects were more common if treatment included injecting a single sperm into an egg, which is done in many cases these days, especially if male infertility is involved. About 10 percent of babies born this way had birth defects versus 6 percent of those conceived naturally, the study found. ..."

There is not enough evidence to say that ICSI procedures are safe in females with hepatitis B in regard to vertical transmission to the offspring, since the puncture of the oocyte can potentially avail for vertical transmission to the offspring.[21]

Follow-up on fetus

In addition to regular prenatal care, prenatal aneuploidy screening based on maternal age, nuchal translucency scan and biomarkers is appropriate. However, biomarkers seem to be altered for pregnancies resulting from ICSI, causing a higher false-positive rate. Correction factors have been developed and should be used when screening for Down syndrome in singleton pregnancies after ICSI,[22] but in twin pregnancies such correction factors have not been fully elucidated.[22] In vanishing twin pregnancies with a second gestational sac with a dead fetus, first trimester screening should be based solely on the maternal age and the nuchal translucency scan as biomarkers are significantly altered in these cases.[22]

See also

References

  1. ^ Hull et al., 1985
  2. ^ Devroy et al., 1998
  3. ^ Boulet SL, Mehta A, Kissin DM, Warner L, Kawwass JF, Jamieson DJ (2015). "Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection". JAMA. 313 (3): 255–63. doi:10.1001/jama.2014.17985. PMC 4343214. PMID 25602996.
  4. ^ a b French DB, Sabanegh ES, Goldfarb J, Desai N (March 2010). "Does severe teratozoospermia affect blastocyst formation, live birth rate, and other clinical outcome parameters in ICSI cycles?". Fertil Steril. 93 (4): 1097–1103. doi:10.1016/j.fertnstert.2008.10.051. PMID 19200957.
  5. ^ Third Party Assisted Conception Across Cultures: Social, Legal and Ethical Perspectives. Jessica Kingsley Publishers. 2004. ISBN 9781843100843. {{cite book}}: Cite uses deprecated parameter |authors= (help)
  6. ^ Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte[permanent dead link]. G Palermo, H Joris, P Devroey, AC Van Steirteghem - Lancet, 1992
  7. ^ Lanzendorf SE, Maloney MK, Veeck LL, Slusser J, Hodgen GD, Rosenwaks Z (1988). "A preclinical evaluation of pronuclear formation by microinjection of human spermatozoa into human oocytes". Fertility and Sterility. 49 (5): 835–42. doi:10.1016/S0015-0282(16)59893-8. PMID 3360172.
  8. ^ S.Abdelmassih; J. Cardoso1; V. Abdelmassih; J. A. Dias; R. Abdelmassih; Z. P. Nagy (2002). "Laser-assisted ICSI: a novel approach to obtain higher oocyte survival and embryo quality rates" (PDF). Human Reproduction. 17 (10): 2694–2699. doi:10.1093/humrep/17.10.2694.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  9. ^ Fauser, Bart; Devroey, Paul (27 October 2011). Baby-Making: What the New Reproductive Treatments Mean for Families and Society. OUP Oxford. ISBN 9780199597314 – via Google Books.
  10. ^ Van Steirteghem, André (1 January 2012). "Celebrating ICSI's twentieth anniversary and the birth of more than 2.5 million children—the 'how, why, when and where'". Human Reproduction. 27 (1): 1–2. doi:10.1093/humrep/der447 – via humrep.oxfordjournals.org.
  11. ^ "Introduction". Pregnancy After Assisted Reproductive Technology (PDF). Cambridge University Press. ISBN 9781107006478. {{cite book}}: Unknown parameter |editors= ignored (|editor= suggested) (help)
  12. ^ Joris, H (1998). "Intracytoplasmic sperm injection: laboratory set-up and injection procedure" (PDF). Human Reproduction (Oxford, England).
  13. ^ [1]
  14. ^ "New Sperm Selection Technology for Assisted Reproductive Technology (ART) Cleared by FDA".
  15. ^ K.C. Worrilow, et al. "Use of hyaluronan in the selection of sperm for intracytoplasmic sperm injection (ICSI): significant improvement in clinical outcomes- multicenter,double-blinded and randomized controlled trial." Human reproduction 28(2):306-14 (2013)
  16. ^ a b Van Der Linden, M.; Buckingham, K.; Farquhar, C.; Kremer, J. A. M.; Metwally, M. (2012). "Luteal phase support in assisted reproduction cycles". Human Reproduction Update. 18 (5): 473. doi:10.1093/humupd/dms017.
  17. ^ Kyrou, D.; Kolibianakis, E. M.; Fatemi, H. M.; Tarlatzi, T. B.; Devroey, P.; Tarlatzis, B. C. (2011). "Increased live birth rates with GnRH agonist addition for luteal support in ICSI/IVF cycles: A systematic review and meta-analysis". Human Reproduction Update. 17 (6): 734–740. doi:10.1093/humupd/dmr029. PMID 21733980.
  18. ^ Farquhar, Cindy; Rishworth, Josephine R; Brown, Julie; Nelen, Willianne LDM; Marjoribanks, Jane (15 July 2015). "Assisted reproductive technology: an overview of Cochrane Reviews". Cochrane Database of Systematic Reviews (7). John Wiley & Sons, Ltd: CD010537. doi:10.1002/14651858.cd010537.pub4. PMID 26174592.
  19. ^ Speyer BE, Pizzey AR, Ranieri M, Joshi R, Delhanty JD, Serhal P (May 2010). "Fall in implantation rates following ICSI with sperm with high DNA fragmentation". Hum Reprod. 25 (7): 1609–1618. doi:10.1093/humrep/deq116. PMID 20495207.
  20. ^ "Genetic considerations related to intracytoplasmic sperm injection (ICSI)". Fertility and Sterility. 86 (5): S103–S105. doi:10.1016/j.fertnstert.2006.07.1489.
  21. ^ Lutgens, S. P. M.; Nelissen, E. C. M.; Van Loo, I. H. M.; Koek, G. H.; Derhaag, J. G.; Dunselman, G. A. J. (2009). "To do or not to do: IVF and ICSI in chronic hepatitis B virus carriers". Human Reproduction. 24 (11): 2676–2678. doi:10.1093/humrep/dep258. PMID 19625309.
  22. ^ a b c Gjerris, Anne Catherine; Ann Tabor; Anne Loft; Michael Christiansen; Anja Pinborg (2012). "First trimester prenatal screening among women pregnant after IVF/ICSI". Human Reproduction Update. 18 (4): 350–359. doi:10.1093/humupd/dms010. PMID 22523111.

External links

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