Intra-Cytoplasmic Sperm Injection (ICSI) is one of the most advanced assisted reproductive techniques used to treat severe male infertility treatment in Pakistan. It is a specialized form of In Vitro Fertilization (IVF) in which a single sperm is directly injected into the cytoplasm of a mature egg. The process sounds complex, but when broken down, it follows a clear and well-structured set of steps.
Step 1: Initial Consultation and Fertility Assessment
Before beginning ICSI, both partners undergo a comprehensive fertility evaluation. This includes:
- Hormonal blood tests
- Semen analysis for the male partner
- Ultrasound of the female reproductive organs
- Medical history review and physical exams
The fertility specialist will confirm if ICSI is suitable, especially in cases like low sperm count, poor sperm motility, abnormal sperm morphology, or previous IVF failure.
Step 2: Ovarian Stimulation
The female partner begins hormone therapy to stimulate her ovaries to produce multiple mature eggs. This typically involves:
- Daily injections of fertility hormones (FSH and LH)
- Regular ultrasounds and blood tests to monitor follicle development
- Adjustments in medication dosage based on response
This step usually lasts 8 to 14 days and helps maximize the number of eggs available for fertilization.
Step 3: Egg Retrieval (Ovum Pick-Up)
Once the eggs are mature, an injection of hCG (trigger shot) is given to prepare for egg collection. About 34–36 hours later, the egg retrieval procedure takes place.
- Performed under sedation or light anesthesia
- A thin needle is guided through the vaginal wall into the ovaries using ultrasound
- Fluid from the follicles is aspirated, and eggs are collected
This procedure typically takes 20 to 30 minutes and the patient can return home the same day.
Step 4: Sperm Collection
On the same day as egg retrieval, the male partner provides a semen sample. In certain cases where sperm is not present in the semen (e.g., azoospermia), surgical techniques like TESA, PESA, or micro-TESE are used to retrieve sperm directly from the testicles.
The best quality and most motile sperm are selected under a microscope for injection.
Step 5: Sperm Injection into the Egg (ICSI)
This is the core step of the procedure and is performed in the laboratory:
- Using a high-powered microscope and micromanipulation tools
- A single, healthy sperm is picked up with a fine glass needle
- It is then carefully injected into the center (cytoplasm) of a mature egg
This increases the chances of fertilization, especially when the sperm cannot penetrate the egg on its own.
Step 6: Embryo Culture
After the ICSI process, the fertilized eggs are placed in a special incubator to grow.
- Embryos are monitored for 3 to 5 days
- Embryologists assess cell division, quality, and development
- The best-quality embryos are selected for transfer
In some cases, clinics may perform preimplantation genetic testing (PGT) on embryos before transfer.
Step 7: Embryo Transfer
The final step is the transfer of one or more embryos into the woman’s uterus.
- Performed using a thin catheter under ultrasound guidance
- No anesthesia is needed; it’s usually painless and quick
- The goal is for the embryo to implant and start a pregnancy
Doctors may also freeze extra embryos for future use.
Step 8: Luteal Phase Support and Pregnancy Test
After the transfer:
- Progesterone supplements are prescribed to support the uterine lining
- A blood test is done 10 to 14 days later to check for pregnancy
If successful, the woman begins prenatal care. If not, the doctor discusses next steps or future attempts.
Final Thoughts
The ICSI procedure is a remarkable advancement in fertility treatment that has helped thousands of couples achieve parenthood, especially in cases of severe male infertility. Each step from stimulation to sperm injection and embryo transfer is carefully planned and executed by experienced specialists.
If you’re considering icsi treatment, understanding these steps can help ease your worries and give you a clearer picture of what to expect on your fertility journey.
