ICSI Intra-cytoplasmic sperm injection

• Introduction

  Intracytoplasmic sperm injection (ICSI) is performed as part of in the in vitro fertilization (IVF) procedure. It is a process in which an embryologist injects a single sperm into the cytoplasm (centre) of each egg and observes the egg over the next day or so. If fertilization occurs and the embryo matures properly, a doctor can transfer it into the uterus.

  In a normal ovulation cycle, one egg matures per month. The goal of an ICSI cycle is to have many mature eggs available to increase chances of success with treatment. This is achieved through stimulation of the ovaries.

• Stimulation of the ovaries

  In the stimulation phase, injectable medications are used for approximately 8 to 14 days to stimulate the ovaries to produce eggs. During this phase, a patient will come into the clinic up to 8 times for morning monitoring and medication adjustment if needed.

• Egg retrieval

  On the morning of egg retrieval, a patient will meet a doctor and an anaesthetist to review their medical history including sperm samples being used. Intravenous fluid will be administered to induce sleep. The egg retrieval itself takes about 20 to 30 minutes via ultrasound and removal of egg via a needle.

  The andrology laboratory will wash and prepare the sperm so the healthiest sperm are brought together with the eggs for fertilization (after the doctor performs the egg retrieval).

• Fertilisation

  After the egg retrieval, the embryologist will prepare the eggs and sperm. For Pre-implantation genetic testing (PGD) the embryologist will inject one single sperm into each mature egg under a microscope. PGD is therefore possible with very few sperm.

• Embryo development

  Embryo development begins after fertilization. An embryologist examines each developing embryo over the course of the following 5 to 6 days to see progressive development.

• Embryo transfer

  The embryo transfer is a simple procedure that only takes about 5 minutes to complete. There is no anaesthesia or recovery time needed. A patient will review their cycle with the doctor and the number of embryos recommended for transfer. The nurse will give the patient instructions for the following 2 weeks until it's time for the pregnancy test.

• The pregnancy test

  Two weeks after the embryo transfer, in the privacy of their own home, a patient will perform a pregnancy test and advises the outcome so Glasgow Royal Fertility Clinic can plan the next steps.

1. What can be done to improve sperm quality?

   • Sperm quality on the day of egg retrieval is often related to what happened in the male’s body 3 months ago. This is because sperm development takes 3 months. Listed below are guidelines to help ensure the semen specimen is of the best possible quality.
   • A fever of 38.5 degrees centigrade or higher within 3 months prior to ART treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. If you become sick during the IVF cycle, please notify the GRFC nurse, and take paracetamol to keep your temperature below 38.5 degrees centigrade.
   • Discontinue alcohol and cigarette use before and during IVF treatment. Do not use any “recreational”/illegal drugs.
   • If any prescription medication has been taken during the last 3 months, notify the GRFC nurse.
   • Do not sit in hot tubs, spas, jacuzzis, or saunas during or 3 months prior to the IVF cycle.
   • Do not begin any new form of endurance exercise during or 3 months prior to the IVF cycle. Physical activity at a moderate level is acceptable and encouraged.
   • Avoid all testosterone and Androstenedione/Androstanediol hormone containing supplements. Do not take any gym supplements
   • Tell your infertility doctor if you have ever had genital herpes, or suspect you may have been exposed to genital herpes in the past. Also tell your doctor if you have pre lesion symptoms, develop a lesion, or have healing lesions before or during the ART cycle.
   • Refrain from ejaculation for 2-3 days, but not more than 5 prior to collecting the semen sample for the IVF cycle. The GRFC nurse will provide you with your specific instructions from the Andrologist.

2. What is happening while I wait for my pregnancy test- The Two Week Wait

   For most patients who undergo fertility treatment, the two-week wait before you have your beta (pregnancy test) can seem like an eternity. Each day seems longer than the last, and the question “Am I pregnant?” goes through your mind hundreds of times a day. One becomes hyper-aware of your body’s every sensation. We all sympathize and wish there was some medical way to make the time shorter or easier for you. So we gathered some questions from our community, ran them by our nurse educators, and came up with some answers to your pressing two-week wait questions.

3. What is the two-week wait?

   The two-week wait is the period of time between the end of your fertility treatment cycle and beta hCG urine test – the test that determines whether or not you’re pregnant. It takes about two weeks from the time a fertilized egg implants in the uterine wall to start emitting enough of the hormone hCG (human chorionic gonadotropin) to be detected by a urine test. We sometimes call the test a “beta” because the test actually measures a beta chain portion of the hCG hormone molecule and is officially named a ‘beta HCG “ test.

4. What is happening to my body during the two-week wait?

   During this time, you may feel as if you are about to start your period. Your body has been through a lot and the medications you’re taking are designed to promote the optimal environment for pregnancy. You may experience some cramping, spotting or light bleeding, abdominal bloating, fatigue, and breast tenderness. While you may be slightly alarmed to experience some of these symptoms, they are normal and do not signify that you are or are not pregnant. Please note, if after your treatment you feel excessive bloating, shortness of breath, chest pain, or lower abdominal pains, you may have ovarian hyperstimulation and should call your clinical team immediately.

5. Will I be taking medications during this time?

   Yes. Most patients need to continue to take progesterone supplements in order to produce the same levels of hormones that would occur in early stages of pregnancy.

6. Can I continue my normal day-to-day activities during the two-week wait?

   We tell all of our patients to be cautious during their first five days after their treatment. We recommend that you refrain from strenuous physical activities as well as sexual activities during that time as they may cause uterine contractions that might impair the implantation process. There is also a greater risk during that time of ovarian issues arising since, for many patients, the ovaries are still slightly enlarged at that point. After those first few days, you can to start light aerobic activities such as yoga, swimming , moderate walking and swimming, and lightweight training on stairmaster or elliptical trainers – activities that can get their heart rate up, but are not demanding, impact on their bodies like jogging or impact aerobics or treadmills.

7. Do I need to adjust my diet during this time?

   No special diet is required, but we recommend that you start making nutritional choices as if you’re already pregnant. This means eating well balanced meals, no sushi or other raw or undercooked meats, avoiding high-mercury fish and soft cheeses, no alcohol, and continuing to take a preconception supplement. Click here to learn about the difference between preconception and prenatal vitamins.

8. Can I travel during the two-week wait (or thereafter if pregnant)?

   We prefer that patients avoid travelling for the first few days post-treatment, primarily so that you are close to our centre for examination should any problems develop. This is also true during and following the time of your pregnancy testing and ultrasound. Early pregnancy complications such as hyper stimulation, bleeding or pain can occur and we would want you near our team here for care. In addition, the rigours of travel, time zone changes, luggage, etc. leave you vulnerable to complications. Before you schedule to travel during this period of time, check with your nurse and team to see if this is at all advisable.

9. What levels of hCG will determine if I’m pregnant?

   Any positive level of beta hCG indicates a pregnancy has started (unless the test is done to early following an HCG trigger injection). We will then have you come in for ultrasounds usually between 6-7 weeks to determine if the embryo continues to develop into a fetus. At about 8+ weeks, GRFC will refer you back to your local antenatal clinic to continue your antenatal care.

10. If I am pregnant, how do you ‘count’ how far along we are?

    As soon as it is determined that you are pregnant, we revert to the Obstetrical counting / dating system. This is done to avoid using one set of dates from the time of an IUI or IVF versus another set of dates used by obstetricians. The doctors determine pregnancy dating to be from the last menstrual period, at least 2 weeks prior to ovulation. Obviously, we often know more about when ovulation may have occurred than usually they do, but for convention we add two weeks to our dates to conform with the obstetric team. As an example, if we know when ovulation was triggered and an IUI or IVF was performed, your beta might be two weeks thereafter. If it is positive, the obstetrician would say you are FOUR weeks pregnant, not two, and therefore so do we. You first early pregnancy ultrasound is usually scheduled for you between 6-7 weeks Gestational Age. That is actually only 4-5 weeks from your IUI or embryo transfer. You just saved two weeks off the length of the 40 week pregnancy!!

11. What are my next steps if I’m not pregnant?

    If you aren’t successful, your nurse will advise you to stop your medications. You will have the opportunity to talk with your doctor to review the past cycle and make a decision together about your next steps.

12. How long after a failed cycle can I do another cycle?

    While your doctor will determine the timing of a new cycle, it’s not always necessary to take time off between cycles unless otherwise directed. Many of our patients are able to begin their next treatment cycle immediately and for many a cycle of rest is recommended.

13. Do you have any BMI or age limits to treatment?

    We want to ensure that you have the best possible chance of having a healthy pregnancy, and so we adhere to British Fertility Society Guidelines on an upper body mass index limit of 35 kg/m2.

    For those women who need to lose weight, we recommend the Counterweight Plus scheme which has been endorsed by the NHS.

    For women using their own eggs we treat up to the age of 50 years old but you need to fully appreciate the very low likelihood of success with advanced maternal age. For women using an egg donor, it is 50 years.

Fees

Our full price list can be found here for download. Should you have any questions about the fees, please contact us on 0141 956 0509 and speak to a member of staff.