ICSI - Fertility. ICSI is a procedure. What is the difference between IVF and ECO + ICSI?

A large number of infertile couples were able to become parents of long-awaited babies due to the introduction of assisted reproductive technologies. Artificial in vitro fertilization (IVF) is the most progressive method. Indications for its use are various types of infertility, both female and male. Depending on the pathology, the effectiveness of the procedure can reach 50% or higher. ICSI-fertilization is a highly effective variant of IVF.

A bit of history

For the first time the method of in vitro fertilization was applied in England in 1976. But, unfortunately, this pregnancy was ectopic (ectopic). But already in 1978, Born Hall - the first child "from a test tube" was born in the same clinic. His mother, Louise Brown, removed the fallopian tubes. And in 1993 in Belgium, the first ICSI-Fertility. Feedback about the procedure, for the most part, speaks about the high effectiveness of this method. But each case is unique, and of course there can be no firm confidence in both positive and negative results.

How is the procedure of in vitro fertilization carried out?

First of all, you need to undergo a thorough medical examination. Since the procedure is carried out "in vitro", from the body of a woman and a man are extracted sex cells. To do this, with the help of medicines, the mother's mother is stimulated by the maturation of the oocytes and prepares the endometrium for pregnancy. After reaching the required parameters, the method of puncture from the ovary extracts the eggs. In order for fertilization to take place, they are placed in a test tube with seminal fluid, where the conditions are similar to natural ones. After three to five days, viable embryos are transported to the uterine cavity. As a rule, three or four embryos are transferred, as some can be rejected by the female organism and only one of them will develop. But as a result of IVF, a multiple pregnancy may also occur.

What is the difference between IVF and ECO + ICSI?

With traditional IVF, the egg cell, along with the spermatozoa, is placed in a special medium, where fertilization proceeds in the natural way (self-introduction of the spermatozoon into the cytoplasm of the egg). ICSI procedure Involves the introduction of a sperm into the egg by injection with a micro needle. From the quality of sperm, pregnancy and the frequency of its onset, as a rule, do not depend. The procedure requires the presence of at least one qualitative sperm.

How does ICSI work?

After the completion of all the preparatory stages (as with conventional IVF): stimulation of the ovaries, puncture, collection and processing of sperm, preparation of the egg for fertilization begins. To do this, the embryologist uses a special reagent to remove its protective layers. Under the microscope, the most active sperm is selected. Both cells are placed in a special sterile medium with the necessary temperature. Then, using a special micropipette, fix the egg cell, separate the tail from the sperm and place it in the microneedle. The embryologist using manipulators is extremely cautious, observing what is happening in the microscope and controlling each of his movements introduces the spermatozoon into the egg. The ICSI procedure is now complete. Now it is necessary to wait for the fertilization and first division of the cell to occur. What is the difference between IVF and ECO + ICSI? Besides the procedure of conception? Strictly speaking, the differences end there. After successful fertilization, the woman will be under the constant supervision of doctors the same way as after the IVF program.

In what situations is the ICSI procedure shown?

Fertilization by ICSI Are carried out in the most severe forms of male infertility, which can not be treated. For example:

• Azoospermia - complete absence of spermatozoa in the ejaculate.

• Teratozoospermia - the presence of spermatozoa, having a normal configuration, in an amount of less than 14%.

• Oligozoospermia - insufficient number of spermatozoa.

• Congenital absence of vas deferens.

• Condition after vasectomy.

In addition, the ICSI method Is used for poor indicators of qualitative and quantitative sperm composition, low quality of "thawed" spermatozoa, unsuccessful attempts of previous IVF, infertility of undetermined origin.

How to prepare for the procedure?

Before the ICSI procedure, a woman and a man must pass a number of tests:

• Blood type, Rh factor;

• syphilis;

• AIDS;

• Hepatitis C, B.

The results of the tests are valid for the next three months.

A woman should conduct such studies as:

• Blood test for hormones (FSH, LH, prolactin, estradiol, testosterone, progesterone, TTG, DGA-S);

• A smear from the genital tract for the presence of hidden infections and STDs;

• A biochemical and clinical blood test;

• Urinalysis is common;

• Smear on the flora;

• Blood clotting analysis.

Also, preparation for ICSI involves mandatory consultation with a gynecologist, to determine possible contraindications.

For men, the most important study in preparing for the procedure of fertilization is a spermogram. It is through this analysis that a man's ability to conceive is determined. The spermogram reveals the quantitative and qualitative characteristics of spermatozoa, and also consists of the following studies:

• Spermotest - analysis of the ability of spermatozoa to maintain mobility in a test tube;

• Determination of the number of leukocytes in the sperm ;

• Detection of infections;

• MART-test;

• Analysis of stained smear.

On the day of egg puncture, a woman is forbidden to take food, drink only after the doctor's permission. A man three to four days before the procedure should refrain from sexual relations, within a few days not to take alcohol.

Efficacy of the procedure

ICSI-fertilization leads to conception in 30-60% of cases. It depends on the condition of the sex cells of both women and men (possibly one of them carries genetic anomalies), as well as the qualification of the embryologist who carried out the procedure (during the procedure, the egg cell may be damaged). If fertilization has occurred, the probability that a newly formed cell will develop a healthy embryo is 90-95%. It should be noted that the positive results for multiple pregnancies are lower than for normal pregnancies. If several nuclei are obtained as a result of the procedure, they can be preserved with liquid nitrogen. Such embryos will not lose their qualities even after a few years.

What can affect the result of the procedure?

Successful ICSI-Fertility Depends on various factors:

• Age of partners;

• Causes of infertility;

• Clinics;

• Experience of a doctor;

• State of the egg.

For a positive result of the procedure, active spermatozoa, obtained from male ejaculate, and high quality female oocytes are needed. If a man does not have active spermatozoa, the probability of fertilization decreases.

Selection of physiologically mature sperm

Male factor has a major impact on the development of the embryo. Often the cause of male infertility is a large number of immature spermatozoa in the ejaculate. A mature spermatozoon is able to bind to hyaluronic acid. It is on this that the method of selecting the necessary cell is based. The embryologist-doctor chooses biochemically competent spermatozoa associated with hyalorunan. It is these physiologically mature cells that will be used for the ICSI procedure.

ICSI-fertilization: the cost of the procedure

Every day dozens of women are interested in the effectiveness, the cost of this procedure, looking for a better clinic for the procedure. In Russia, the approximate price of one attempt of ICSI-fertilization is 150-200 thousand rubles. Abroad, the cost of such a procedure is higher. In Israel - about 2 times. In the USA, Germany, Switzerland - 3-4 times.

Possible risks

Despite numerous advantages, ICSI-fertilization Has one serious drawback - the natural selection factor does not work here. This is especially true for representatives of the male with the presence of genetic diseases (for example, Kleinfelter's syndrome and others) that are incapable of conceiving without the use of auxiliary methods. Such pathologies can be inherited and manifested after many years. Genetic failures in future children do not develop due to the procedure of IVF. However, infertility of parents can affect the health of offspring. In order to identify possible chromosomal and genetic abnormalities in a particular embryo, it is recommended to perform pre-implantation diagnostics. This can be done at the stage of more than six blastomeres.

What other methods of in vitro fertilization exist?

GIFT - oocytes and spermatozoa (gametes) are transferred to the fallopian tubes, if at least one of them is high-grade.

ZIFT - fertilized oocytes (zygotes) are transported to the fallopian tubes.

OD - ECO donor oocytes followed by transport of the embryo into the uterus of the recipient. This method is used in the absence of ovaries in a woman or a violation of their functions, genetic abnormalities in the mother, natural menopause.

The "surrogate motherhood" program - embryos of genetic parents for bearing pregnancy are transferred to the womb of another woman. The reason for this may be the absence or inferiority of the patient's uterus, but with the preservation of the function of the ovaries.

The IVF procedure, of course, is expensive and time-consuming, the equipment necessary for fertilization is not available in all clinics, it is also difficult to find a qualified doctor. However, such a program allows many childless couples to experience the greatest joy of motherhood and paternity.