A single sperm being picked up by a micropipette.

Puncturing the zona pellucida with micropipette containing the sperm.

Puncturing the pliable inner membrane of the egg.

Releasing the sperm into the egg.

The micropipette is withdrawn from the egg.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

If there is a question of the sperm's ability to fertilize the egg, due to either a low sperm count or poor quality of the sperm, Intracytoplasmic Sperm Injection (ICSI) can be performed. This technique allows us to inject a single sperm into an egg to achieve fertilization. Many babies have been born with this technique from men who were otherwise considered hopelessly sterile. We are now able to take a single, almost non-moving sperm and inject it into a woman's egg creating a normal embryo and a completely normal baby. The babies born from this technique are physically, mentally, and genetically normal no matter how poor in quality is the sperm of the father. This technique is very cost-effective and the success rate is comparable to couples with normal sperm. The fertilization rate per egg using ICSI is about 70% despite poor sperm.

TESTICULAR SPERM ASPIRATION (TESA)

In cases of severe male factor infertility, genetic abnormalities may be present in the male partner. Such abnormalities might be transferred to any male offspring. Antenatal genetic testing is recommended in these cases. If there is absolutely no sperm in the ejaculate we can perform TESA to remove the few non-moving sperm available. Testicular Sperm Aspiration is performed under local or general anesthesia and there is only brief, minimal discomfort following the procedure. All discomfort should be gone within a few hours. A very fine needle is passed through the skin into the testicles where sperm will be located. These sperm recovered through TESA can then be used to fertilize an egg with the ICSI procedure.

To achieve ICSI fertilization a single washed sperm is located and its tail is crushed so it will be immobilized and not damage the egg after it is injected. It is then picked up with an injection micropipette, a specially prepared ultra-fine, glass needle. A single mature egg is held in place by a holding micropipette and the egg is rotated so that its polar body is at the 12 o'clock position. This insures that the egg is in the proper position so no damage will occur during the injection process. The injection micropipette then punctures the outer zona pellucida of the egg at the 3 o'clock position. It continues inward toward the pliable inner membrane of the egg that is then broken by suction from the injection micropipette. The sperm and a small amount of the egg material are quickly injected back into the egg and the micropipette is removed. Fertilization has been achieved and normal cell division can now take place.