Intracytoplasmic sperm injection
Intracytoplasmic sperm injection | |
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Oocyte is injected during ICSI | |
MeSH | D020554 |
Intracytoplasmic sperm injection (ICSI /ˈɪksi/ IK-see) is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of embryos that may be transferred to a maternal uterus. With this method acrosome reaction is skipped.
There are several differences within classic IVF and ICSI. However, the steps to be followed before and after insemination are the same. In terms of insemination, ICSI needs one only sperm cell per oocyte, meanwhile IVF needs between 50 and 100 thousands. This is due to the fact that in IVF acrosome reaction has to take place and thousands of sperm cells have to be involved. Once fertilized, the egg is transformed into a proembryo and it has to be transferred to the uterus to continue its development.
The first human pregnancy generated by ICS was carried out in 1991 by Gianpiero Palermo and his team.
Indications
![](http://upload.wikimedia.org/wikipedia/commons/thumb/d/db/Blausen_0060_AssistedReproductiveTechnology.png/220px-Blausen_0060_AssistedReproductiveTechnology.png)
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.[1]
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.[2] Even with severe teratozoospermia, microscopy can still detect the few sperm cells that have a "normal" morphology, allowing for optimal success rate.[2]
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.[3]
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.[4]
The procedure itself was first performed in 1987,[5] though it only went to the pronuclear stage.[6] The first activated embryo by ICSI was produced in 1990,[7] but the first successful birth by ICSI took place on January 14, 1992 after an April 1991[8] conception.[9]
Sharpe et al comment on the success of ICSI since 1992 saying, "[t]hus, the woman carries the treatment burden for male infertility, a fairly unique scenario in medical practice. ICSI’s success has effectively diverted attention from identifying what causes male infertility and focused research onto the female, to optimize the provision of eggs and a receptive endometrium, on which ICSI’s success depends."[10][11]
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 provides a sperm sample on the same day when the eggs are collected.[12] The sample is checked in the lab, and if no sperm is present, doctors will extract sperm from the 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).
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/2d/ICSI_Procedure.jpg/240px-ICSI_Procedure.jpg)
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 the sperm is directed into 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.[13] A recent clinical trial showed a sharp reduction in miscarriage with embryos derived from PICSI sperm selection.[14]
'Washed' or 'unwashed' sperm may be used in the process.
Live birth rate are significantly higher with progesterone to assist implantation in ICSI cycles.[15] Also, addition of a GNRH agonist has been estimated to increase success rates.[15][16]
Ultra-high magnification sperm injection (IMSI) has no evidence of increased live birth or miscarriage rates compared to standard ICSI.[17]
Assisted zona hatching (AH)
People who have experienced repeated failed implantation or who have a thick zona pellucida (covering around the embryo) are ideal candidates for assisted zona hatching. The procedure involves creating a hole in the zona to improve the chances of normal implantation of the embryo in the uterus.[citation needed]
Pre-implantation genetic diagnosis (PGD)
PGD is a process in which one or two cells from an embryo on Day 3 or Day 5 are extracted and the cells genetically analyzed. Couples who are at a high risk of having abnormal number of chromosomes or who have an history of single gene defects or chromosome defects are ideal candidates for this procedure. It is used to diagnose a large number of genetic defects at present.[citation needed]
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[18] as measured e.g. by comet assay, advanced maternal age and semen quality.
A systematic meta-analysis of 24 estimates of DNA damage based on a variety of techniques concluded that sperm DNA damage negatively affects clinical pregnancy following ICSI.[19]
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]
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
- ^ 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.
- ^ 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.
- ^ Third Party Assisted Conception Across Cultures: Social, Legal and Ethical Perspectives. Jessica Kingsley Publishers. 2004. ISBN 9781843100843.
{{cite book}}
: Unknown parameter|authors=
ignored (help) - ^ Palermo, G.; Joris, H.; Devroey, P.; Van Steirteghem, A. C. (1992-07-04). "Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte". Lancet. 340 (8810): 17–18. ISSN 0140-6736. PMID 1351601.
- ^ 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.
- ^ 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) - ^ 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.
- ^ 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. PMID 22180598 – via humrep.oxfordjournals.org.
- ^ "Introduction". Pregnancy After Assisted Reproductive Technology (PDF). Cambridge University Press. ISBN 9781107006478.
{{cite book}}
: Unknown parameter|editors=
ignored (|editor=
suggested) (help) - ^ Barratt, Christopher L.R.; De Jonge, Christopher J.; Sharpe, Richard M. (7 February 2018). "'Man Up': the importance and strategy for placing male reproductive health centre stage in the political and research agenda". Human Reproduction. 33 (4): 541–545. doi:10.1093/humrep/dey020. PMC 5989613. PMID 29425298.
{{cite journal}}
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(help)CS1 maint: postscript (link) - ^ Knapton, Sarah (6 March 2018). "IVF to fix male infertility 'infringes human rights of women' argue scientists". The Telegraph. Retrieved 7 March 2018.
- ^ [1]
- ^ "New Sperm Selection Technology for Assisted Reproductive Technology (ART) Cleared by FDA".
- ^ 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)
- ^ 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.
- ^ 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.
- ^ 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): CD010537. doi:10.1002/14651858.cd010537.pub4. PMID 26174592.
- ^ 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.
- ^ Simon L, Zini A, Dyachenko A, Ciampi A, Carrell DT (2017). "A systematic review and meta-analysis to determine the effect of sperm DNA damage on in vitro fertilization and intracytoplasmic sperm injection outcome". Asian J. Androl. 19 (1): 80–90. doi:10.4103/1008-682X.182822. PMC 5227680. PMID 27345006.
{{cite journal}}
: CS1 maint: unflagged free DOI (link) - ^ Practice Committee of the American Society for Reproductive Medicine; Practice Committee of the Society for Assisted Reproductive Technology (2006). "Genetic considerations related to intracytoplasmic sperm injection (ICSI)". Fertility and Sterility. 86 (5): S103–S105. doi:10.1016/j.fertnstert.2006.07.1489. PMID 17055799.
- ^ 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.
- ^ 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.
- Lancet. 1990 Mar 24;335(8691):722-3. Twin birth after subzonal insemination. Fishel S, Antinori S, Jackson P, Johnson J, Lisi F, Chiariello F, Versaci C.
- Gordon, Ian R. Laboratory production of cattle embryos/I. Gordon. -- 2nd ed. 2003 ISBN 0-85199-666-3