ICSI

ICSI TREATMENT IN CHENNAI (A BREAKTHROUGH PROCEDURE)

WHAT IS ICSI ?

ICSI (Intra cytoplasmic sperm Injection) is the best method of fertilization. It is the process of injecting the selected best quality sperm in to the mature egg. ICSI Process involves usage of specialized manipulators and microscope for pickup of selected sperms.

The hollow needle is used to inject the selected sperms in to the inner part of the egg (Cytoplasm). Approximately 70 -85% of eggs injected with best quality sperms show evidence of fertilization which is really good.

PATIENTS SELECTION – WHO REQUIRES ICSI?

This procedure has been considered a breakthrough in the management of patients with below mentioned conditions.

• Men with low sperm count / poor motility.
• Increased number of abnormal sperms.
• Previously failed IVF CYCLE.
• Azoospermia.
• TESA Retrieved sperms – Testicular aspiration of sperms.
• For females where total number of eggs retrieved is less than 5.

ICSI PROCEDURE

• It requires specialized ICSI Microscope and special holding pipette.
• ICSI needles to pick up the sperms and immobilize it.
• The ICSI needle is carefully introduced in to cytoplasm of the egg and the sperm is injected in to the egg and the needle gently removed.
• The eggs are reviewed for growth 18-20 hours later for evidence of fertilization.

IVF/ ICSI – THE PROCESS DAY TO DAY

SUPER OVULATION

In assisted reproduction, chances of conception can be increased by stimulating the ovaries to produce required number of eggs. This is termed as super ovulation and can be brought about by using drugs (Gonadotrophins) which mimic the action of the body’s natural hormones. Drug doses and combinations are calculated for each individual depending on a number of factors Including age, medical history, body mass index, antral follicle count (number of follicles on Day 2) and hormone values. Details will be given to each patient in the form of an individual "Protocol" letter by the medical staff.

The following is a list of drugs, commonly prescribed by the consultants, with a brief description of their actions and possible side effects. Prescription and administration details are specific to each individual and will be fully explained by the medical staff.

IVF / ICSI CYCLE

PROTOCOLS

The actual IVF treatment starts from your previous cycle when you start taking oral contraceptive pills or hormone tablets everyday at 9 pm from a specific date.

You should meet the IVF team on a given date, which would be the day we start the down regulation. The protocol starts with inj GONAPEPTIDE which is given everyday. Alternative options include Inj LUPRIDE, which is a single injection given IM by our specially trained nurses. Oral anblotics are prescribed to prevent vaginal infections. These are normally started on the day of the first Injection.You are first required to do some blood tests which would cost approximately Rs. 6000 INR. All the reports will be reviewed by the medical team. An Internal examination and dilatation of the cervix will be done by the doctor to ensure the exact guidance for embryo transfer. This is called a dummy embryo transfer and will help to map the direction for embryo transfer if you want an anaesthetic you can request it or if the procedure is difficult the doctor will recommend it the consumption of oral contraceptive pills will be discontinued as per the Doctor’s instructions.

A blood test will be done on day 2 of your periods. From Day 3 onwards, patients are required to take injections everyday as per protocol but are free to go home. However we advise mild exercise and a well balanced diet throughout this period. There is no need for complete bed test during the injection. Vaginal ultrasound scan will be done on Day 3 in the morning following which the stimulation injections will be given. From the 8th day onwards, Scan will be done every day or alternate days along with your injections. Dose of injection will be calculated based on hormone values and ultrasound reports by Dr. Geetha An identification number will be given to you. When the follicles mature you will be given Inj HCG at night at a specific time. Pre anaesthetic fitness has to be obtained from the anaesthetist 2 days prior to egg collection. 35-37 hrs after the Injection, the eggs are aspirated under anaesthesia and fertilized.

The eggs are reviewed for growth 18-20 hours later for evidence of fertilization.

You will be required to stay in the hospital for a day 10-12 hour on the day of egg collection, following which, our IVF team will be in close touch with you regarding the day of embryo transfer. You will once again be required to stay in the hospital for a day on the day of Embryo transfer. No anaesthesia is required for the embryo transfer unless specified by the doctor. However if you feel you would like to have the transfer under anaesthesia please inform us well in advance.

ANTAGONIST PROTOCOL

Now more patients go through this protocol as its shorter and saves time with equally good results.

This protocol is used selectively in elderly women and those who are risk of lyper stimulation. Tab, Primolut –N for 5 days is given. Periods start 5 days after stopping the tablet. Stimulation with recombinant FSH and HMG is started on D3 and the antagonist, when the follicle size is around 14 mm on scanning. You will get both the stimulant and the antagonist injections till the follicle size is about 18 – 19 mm when the HCG is given.

On the day of HCG injection, you will receive only the antagonist injection in the morning but no stimulant. The HCG injection is given at night. You have to come the next day for follicular study and the egg retrieval is done 35-37 hours after HCG injection.

MONITORING TREATMENT

All monitoring and treatment is administered on a daily outpatient basis. Please note that you are not required to sleep overnight in the hospital. The progress of your treatment cycle is monitored by:

Blood hormones

1. On the day of down regulation
2. 2nd, 6th ,8th,10th day of cycle
3. On night injection day

Ultrasound scan – This involves the use of a vaginal ultrasound probe which enables us to measure the size of the developing follicles which contains the eggs. It also enables assessment of the endometrial lining of the womb.

Dopplers scans are done to assess the blood flow to the endometrium( Lining of the uterus) This procedure is easier with an empty bladder, painless and for only a few minutes.

A scan can be performed safely even if you have a period. Scan is done on day 3 of periods and daily or alternate days from day 8 till egg collection.

During a treatment cycle each patient’s scan and blood tests are assessed by a team of doctors and Dr.Geetha. It is not always possible to have results available at specific times due to other commitments of the theater and laboratory staff. You may be requested to walt at the waiting room until all results are processed. However we generally ensure that all delays are kept to the minimum. Dosage of drugs are calculated based on scans and homone levels.

HCG – When follicles size have reached a satisfactory level arrangements are made for a HCG injection to be given. This injection is usually administered late in the evening 36 hours prior to egg recovery. You should come to the hospital for this injection.

PARTNERS PRESENCE FOR IVF

A semen culture should be done during the first visit to the hospital and 1 month before starting the injection.

The male partner needs to join you on day 10 for 7 – 8 days during which time he is required to have inter course or ejaculate on day 10. A fresh sample will be taken again on the day of egg collection . if the partner is unable to stay he may alternately freeze the semen sample which would be used during egg collection. Please make it possible to freeze your semen sample as some men are unable to produce a sample on that day, when the frozen sample can be used. The Monitoring phase.

Under response – if 3 or fewer follicles are developing we may advise abandoning the cycle. We then review your stimulation regime to try to improve the situation in future cycles (Though some women consistently produce a low number of follicles ). The cost of drugs and administration charges (approximately 50% ) will be retained and the balance refunded. Over response – If a very large number of follicles are developing and very high estrogen levels are noted, there is a risk of ovarian hyper stimulation syndrome. If it is severe which happens in 1 % of the patients, admission and monitoring in the hospital is necessary.

EGG RETRIVAL – Collection

Egg recovery is accomplished by a transvaginal procedure , which can be performed under light sedation or local anesthesia.

IVF - WITH ICSI Fertilization process.