This is a technique in ART where one sperm is selected and injected into the egg by an embryologist.
It began with the introduction of SUZI (sub zonal insemination) in 1987 at Monash, which was not very successful. The procedure was then further refined by Palermo and Paul Deveroy at Belgium, resulting in the first live birth following the procedure in 1992.
It involves the use of specialised equipment such as micromanipulators and inverted microscopes into the hands of a skilled embryologist.
1.The egg is held in position with the help of a holding pipette such that the polar body is at 6 or 12'o'clock position (to minimise damage to the spindle)
2.A fine, specially developed, hollow, ICSI microneedle is then used to immobilise the sperm by cutting the tail and sucking it into the needle.
3.The needle with the sperm in it is then pierced through the outer covering called the zona and then the oolemma to deposit the sperm directly into the cytoplasm of the oocyte.
4.The egg is checked for signs of fertilisation the following morning.
1. Azoospermia or severe male factor infertility is the main indication for which it is a boon, as so many couples who would have otherwise not had any options are able to have children following its discovery. Sperm obtained by TESE or other surgical procedures can be used for insemination.
2.severe OAT (oligo astheno teratozoospermia) where the counts, motility or morphology may be too low to have good fertilisation rates with standard IVF.
3.Previous failed fertilisation in standard IVF.
4.In a poor prognosis patient with suboptimal yield of eggs to ensure the maximum number of embryos by improved rates of fertilisation.
Following ICSI, the fertilisation rates are about 70 to 85% in the hands of a skilled embryologist.
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