The Ultimate Guide to Intracytoplasmic Sperm Injection (ICSI) in Turkey
What is Intracytoplasmic Sperm Injection (ICSI)?
Intracytoplasmic Sperm Injection (ICSI) is a type of Assisted Reproductive Technology (ART) in which eggs are fertilized with sperm outside the human body. It is a complex procedure that involves retrieving eggs from the ovaries and manually injecting a single sperm into each egg in the laboratory for fertilization. After several days of fertilization, the fertilized egg (now called an embryo) is placed inside the uterus. Pregnancy occurs when the embryo implants into the uterine lining.
Why is ICSI performed?
People choose to undergo ICSI for various reasons, including infertility issues or health conditions affecting either partner. Some opt for ICSI after other fertility treatments have failed or if the woman is of advanced maternal age.
ICSI may be an option if you or your partner experience:
- Blocked or damaged fallopian tubes
- Endometriosis
- Low sperm count or poor sperm quality
- Polycystic ovary syndrome (PCOS) or other ovarian issues
- Uterine fibroids
- Uterine abnormalities
- Risk of passing on a genetic disorder
- Unexplained infertility
How long does the ICSI process take from start to finish?
ICSI is a multi-step process that takes several weeks to complete. On average, the procedure lasts between 4 to 6 weeks, including the period before egg retrieval, during which the individual takes fertility medications. The final step is a pregnancy test to determine the success of the procedure.
How common is ICSI?
Approximately 5% of couples struggling with infertility undergo ICSI. Since 1978, more than 8 million babies have been born as a result of ICSI, making it one of the most effective assisted reproductive technologies.
What Are the Steps of ICSI Treatment?
- Birth Control Pills or Estrogen
Before starting ICSI treatment, your healthcare provider may prescribe birth control pills or estrogen. This step helps prevent ovarian cyst formation and regulates the timing of your menstrual cycle. It improves treatment control and increases the number of mature eggs available for retrieval.
- Ovarian Stimulation
In a natural menstrual cycle, a group of eggs begins to mature, but typically only one egg reaches full maturity for ovulation. During an ICSI cycle, you will take hormonal medications to stimulate multiple eggs to mature at the same time.
Additional Steps for Ovarian Stimulation:
- Monitoring: The response of the ovaries to medication is tracked using ultrasound and blood tests. Monitoring typically lasts 8 to 14 days, assessing the size and number of follicles (small sacs containing eggs) to determine egg maturity.
- Trigger Shot: Once the eggs reach final maturity, you will receive a trigger injection to prepare them for retrieval. This shot must be taken 36 hours before egg retrieval.
- Egg Retrieval
- The doctor uses ultrasound guidance to insert a thin needle into each ovary through the vagina. This needle is connected to a suction device to retrieve eggs from the follicles.
- The eggs are placed in a special solution inside an incubator (a controlled environment).
- Light sedation and pain medication are administered to minimize discomfort during the procedure.
- Egg retrieval is performed 36 hours after the final hormonal injection (“trigger shot”).
- Fertilization
- On the evening of egg retrieval, an embryologist attempts to fertilize all mature eggs using Intracytoplasmic Sperm Injection (ICSI), where a single sperm is injected into each mature egg.
- Immature eggs cannot undergo ICSI. These eggs are placed in a dish with sperm and nutrients, but they rarely mature in the dish. If an egg matures later, sperm in the dish may attempt to fertilize it.
- On average, about 70% of mature eggs are fertilized. For example, if 10 mature eggs are retrieved, around 7 may be successfully fertilized. A fertilized egg then develops into an embryo.
- If there are too many eggs or if you do not wish to fertilize all eggs at once, some can be frozen before fertilization for future use.
Embryo Development
- Over five to six days, embryo development is carefully monitored.
- The embryo must overcome significant obstacles to become suitable for transfer to the uterus. On average, about 50% of fertilized embryos reach the blastocyst stage, which is the optimal stage for transfer.
- For example, if 7 eggs are fertilized, 3 to 4 embryos may reach the blastocyst stage, while the remaining ones fail to develop and are discarded.
- All viable embryos are frozen on day five or six after fertilization for future embryo transfer procedures.
Embryo Transfer
There are two types of embryo transfers: fresh embryo transfer and frozen embryo transfer. Your doctor will discuss the best option based on your specific situation.
- Fresh embryo transfer: The embryo is transferred into the uterus 3 to 7 days after egg retrieval.
- Frozen embryo transfer (FET): Previously frozen embryos (from an earlier IVF cycle or donor eggs) are thawed and transferred into the uterus.
Frozen embryo transfer is often preferred due to better scheduling flexibility and a higher chance of achieving a live birth.
FET requires hormonal medications to prepare the uterus for implantation. This stage typically involves:
- 14 to 21 days of oral medication
- Followed by six days of hormone injections
Pregnancy
Pregnancy occurs when the embryo successfully implants into the uterine lining. A blood test is performed 9 to 14 days after embryo transfer to confirm pregnancy.
Preparation for ICSI Treatment
Before starting treatment, a comprehensive medical evaluation and fertility tests are required. Some essential preparations include:
- Consultation about the ICSI procedure
- Uterine examination, Pap smear, and breast imaging (for women over 40)
- Semen analysis
- Screening for sexually transmitted infections (STIs) and infectious diseases
- Ovarian reserve testing, blood tests, and urine analysis
- Uterine cavity assessment using hysteroscopy or ultrasound imaging
Post-ICSI Care
After embryo transfer, you may experience mild symptoms such as bloating, cramping, or light spotting. A pregnancy test is conducted 9 to 14 days after the transfer to confirm implantation.
How Do ICSI Injections Work?
During an ICSI cycle, you will take hormonal injections to stimulate all the eggs in your ovarian cycle to mature simultaneously. Your doctor will determine the type, dosage, and frequency of the medications based on your age, medical history, hormone levels, and response to previous ICSI cycles (if any). You can expect to use fertility medications for 8 to 14 days.
What Medications Are Used in ICSI?
Several medications may be used during an ICSI cycle. Some are taken orally, while others are injected, absorbed through the skin, or inserted vaginally. Your doctor will tailor dosages and timing to your treatment plan.
During Ovarian Stimulation, You May Receive the Following Injections:
- Follicle-Stimulating Hormone (FSH): This hormone stimulates the ovaries to produce eggs. You may receive one or a combination of FSH medications for up to 14 days.
- Human Chorionic Gonadotropin (hCG): Often given as a final injection to trigger egg maturation and stimulate ovulation.
- Leuprolide Acetate: A type of Gonadotropin-Releasing Hormone (GnRH) agonist, administered via injection to regulate ovarian stimulation or as a trigger shot.
Additional Medications
- Birth control pills or hormonal injections may be prescribed before starting ICSI to regulate your cycle, ensuring that all eggs develop at the same time.
- Estrogen supplements may be recommended before and after embryo transfer to improve uterine lining thickness.
- Progesterone supplements are commonly added to increase the chances of embryo implantation and support early pregnancy.
These medications may be administered orally, via injection, through the skin, or vaginally. Most patients continue taking these hormones for the first three months of pregnancy to support a successful implantation and pregnancy.
What is Assisted Hatching in ICSI?
Assisted hatching is a technique used in ICSI treatment. It involves creating a small opening in the outer shell of the embryo before transferring it to the uterus. This opening helps the embryo “hatch” from its outer shell more easily.
For a successful pregnancy, the embryo must hatch and attach to the uterine lining. Assisted hatching gives the embryo a better chance of implanting in the uterus. This technique is particularly beneficial for patients who have undergone multiple failed IVF cycles.
What Are the Risks of ICSI?
ICSI treatment carries several risks, including:
- Multiple births: Carrying twins or more increases the risk of preterm labor.
- Premature birth: There is a slightly higher chance of having a preterm baby or a low birth weight baby.
- Miscarriage: The miscarriage rate is similar to that of natural pregnancies.
- Ectopic pregnancy: A condition where the embryo implants outside the uterus.
- Egg retrieval complications: Risks include bleeding, infection, or damage to the bladder, intestines, or reproductive organs.
- Ovarian Hyperstimulation Syndrome (OHSS): A rare condition that can cause abdominal pain, nausea, vomiting, diarrhea, rapid weight gain, bloating, difficulty breathing, and trouble urinating.
What Are the Common Side Effects of ICSI?
Fertility medications used during ovulation stimulation may cause side effects such as:
- Nausea and vomiting
- Hot flashes
- Headaches
- Ovarian enlargement
- Abdominal pain
- Bruising at the injection site
After embryo transfer, you can resume normal activities, but you may experience some discomfort due to ovarian enlargement. Common side effects after embryo transfer include:
- Constipation
- Bloating
- Cramping
- Breast tenderness (due to increased estrogen levels)
- Light spotting
Is Pregnancy from ICSI Considered High-Risk?
Pregnancy resulting from ICSI is not automatically considered high-risk. However, it may be classified as high-risk if the mother has medical conditions such as advanced maternal age, multiple pregnancy (twins or more), or high blood pressure.
How Effective Is ICSI in Achieving Pregnancy?
Age is one of the most significant factors affecting ICSI success. The chances of pregnancy are higher for women under 35 and lower for women over 40.
Live birth rates vary greatly by age. For example:
- Under 35 years old: The live birth rate using the woman’s own eggs is approximately 46%.
- At 38 years old: The live birth rate drops to about 22%.
How Long Does It Take to Confirm Pregnancy After ICSI?
It takes approximately 9 to 14 days after embryo transfer to test for pregnancy. The exact timing may vary depending on the clinic. Doctors typically use a blood test to detect pregnancy by measuring hCG levels, a hormone produced by the placenta during pregnancy.
When Can You Try Again After a Failed ICSI Cycle?
Most fertility clinics recommend waiting for a full menstrual cycle before starting another ICSI cycle. Since menstrual cycle lengths vary, you can typically begin a new cycle about 4 to 6 weeks after a negative pregnancy result.
When Should You Contact Your Doctor?
If you are undergoing ICSI treatment, contact your doctor if you experience any of the following:
- Fever above 38.05°C (100.5°F)
- Blood in urine
- Heavy vaginal bleeding
- Severe pelvic pain
Can You Improve Your Chances of a Successful Pregnancy with ICSI?
Several factors influence ICSI success, some of which are within your control, while others are not. Key factors include:
- Age
- Height and weight (BMI)
- Previous childbirth history
- Total number of past pregnancies
- Use of your own eggs vs. donor eggs
- Number of ICSI cycles attempted
- Overall health conditions
- Cause of infertility
Your doctor will work closely with you to determine the best strategies for increasing your chances of pregnancy based on your medical history and specific situation.
ICSI Success Rates by Age
According to collected data, success rates are measured per egg retrieval rather than per cycle. In 2019, the live birth rate per egg retrieval was:
- Under 35 years old: 46.7%
- Ages 35-37: 34.2%
- Ages 38-40: 21.6%
- Ages 41-42: 10.6%
- Over 43 years old: 3.2%
Why Does ICSI Fail?
ICSI treatment can fail at various stages due to multiple factors, including:
- Premature ovulation
- Poor egg development
- Overproduction of eggs
- Failure of the sperm to fertilize the egg
- Poor sperm quality
- Embryo failing to develop or implant
- Issues during egg retrieval or embryo transfer
Your doctor will analyze each step to determine the best approach for future treatments.
Does ICSI Increase the Risk of Birth Defects?
It is not definitively known whether ICSI alone increases birth defects. In natural pregnancies, about 2% of babies are born with birth defects. Some studies suggest a slightly higher risk for babies born through ICSI, but this may be due to age-related factors or the underlying infertility condition rather than the procedure itself.
What Is the Best Age to Start ICSI?
Research indicates that pregnancy and live birth rates after ICSI begin to decline after age 35 and drop significantly after age 40.
Should Embryos Be Frozen During ICSI Treatment?
Embryo freezing is a common part of ICSI programs. Some choose to freeze and store embryos for future pregnancy attempts. Embryos can be frozen for several years, but not all embryos survive the freezing and thawing process.
Turkey Healthcare Group stands out with a team of distinguished medical experts in Turkey, who always strive to provide the best healthcare services to patients.
If you are looking for exceptional healthcare or need medical consultation from top doctors, feel free to contact us.
We also invite you to view our leading medical staff and get to know their qualifications and experiences up close.
We are here to ensure you receive the best possible healthcare.
