Dr Gautam Allahbadia on what is ICSI & how is it beneficial?
According to the World Health Organization, the incidence of infertility is about 10% worldwide. The WHO data has further concluded that in most developing countries, one out of four ever-married couples of reproductive age are infertile because of primary or secondary infertility. Misconceptions are very common in the world of infertility.
One popular myth is that infertility is the “woman’s problem” and once that problem is fixed, the couple will be able to conceive. This is far from the truth. Data collected over the last twenty years reveal that infertility is due to a male factor in almost 30% of cases. In another 30% of cases there is a combined male and female factor. Therefore, the male factor is at least partly responsible in about 60% of infertile couples.
Stress and environmental pollution are two of the main causes of growing infertility among urban couples. Stress plays a very important role, and often couples conceive when the stress factor is removed from their lives. Late marriages, choosing career over babies, changing food habits, environmental pollution are just some of the subtle factors silently contributing to the growing incidence of infertility. The final nail in the coffin is stress that stems from work, from peers, from relatives and ultimately from the infertility itself, forming a vicious cycle.
Less than a decade ago, treatment for a severe male factor limited to inseminations or IVF using donor sperms. Today, newer advances in male infertility have introduced innovative therapeutic options that offer men, including ones with no sperms in their ejaculate, a greatly improved chance to conceive their own biological child as per Dr Gautam Allahbadia from Mumbai.
Intracytoplasmic sperm injection
ICSI is a procedure that can be used as a part of IVF (in vitro fertilization) or test tube baby treatment. It was introduced in 1992 and was welcomed as a breakthrough in fertility treatment where the problem is on the man’s side. Since then, it has become the most successful technique in male infertility treatment, replacing older techniques. In ICSI only one sperm is needed, which is directly injected into each egg to make it fertilize.
Who might benefit?
As per Dr Gautam Allahbadia ,ICSI can offer real hope to couples where the man has a very low sperm count, produces few good quality sperms, or has a problem with anti-sperm antibodies in his semen. In fact it can also help in cases where there are absolutely no sperms in the semen (azoospermia). Sometimes in such cases sperms are actually produced in the testes but do not come out. The man may have had an irreversible vasectomy, or has no sperm in his semen due to missing tubes or blockages in his reproductive organs.
These sperms can be retrieved from the testes directly and used to fertilize the eggs by ICSI. This procedure thus offers an alternative to the use of donor sperms; an option that is preferred by many as it gives them a chance to have their own biological child. Couples who have tried IVF can move on to ICSI if not enough eggs could be retrieved from the female partner; or if fertilization has failed with standard IVF.
How does it help?
With ICSI, the sperm do not have to travel to the egg or penetrate the outer layers of the egg. Therefore it can help men whose sperm are too few, or cannot move properly, or where the sperm can get to the egg, but are unable to fertilize it for some reason. In ICSI each sperm is picked up by a micromanipulator and physically injected into each egg thereby making it fertilize. Two days later the fertilized eggs become balls of cells called embryos. These embryos are then transferred into the lady’s uterus by a fine catheter.
What is the success rate?
The success rate of ICSI is increasing as more and more clinics become experienced in this technique. The overall average success rate for women under 35 years is around 30%.
What are the advantages?
ICSI opens doors to parenthood that were previously closed for couples with a male factor problem. It gives men with absent, few or immotile sperms the chance to have their own biological child, which might not have been possible without this technique. Sperms can also be retrieved from the testes of men who have in the past undergone a vasectomy that now cannot be reversed.
What are the disadvantages?
Nature follows the principle ‘Survival of the fittest’. During normal conception, only the hardiest sperm manage to travel great distances and break through the membrane of an egg to fertilize it. Weaker sperm never make it. Because ICSI bypasses this process of natural selection, critics worry about higher rates of miscarriage, and long-term health & developmental problems for children conceived using whatever sperm are available. Research so far has been reassuring about most potential risks. No impact has been seen on the cognitive and motor skills of children conceived using ICSI.