ICSI in Tunisia

Indications

ICSI or intracytoplasmic sperm injection is a technique that involves injecting a single sperm directly into each oocyte using an inverted microscope with micromanipulators (kinds of joysticks to move in three spatial planes, connected to gates metal pipettes). This technique is initially indicated within severe forms of male sterility that has seen its use expanding to other causes of infertility.

The ovulation stimulation and oocyte collection are identical to those of the in vitro fertilization. The sperm used may be collected by fresh masturbation or previously frozen sperm. If necessary, you can also collect sperm from the testicle or epididymis.

Once ICSI is performed the following steps are the same as those for in vitro fertilization.

There is currently a variant of ICSI: This is the IMSI (Intra cytoplasm, morphologically selected Sperm Injection). This is ICSI with a sperm cell sorting at a high magnification (* 5000 to 10000 against a magnification of 400 * for ICSI) optimizing the selection of the sperm based on the morphology.

The associated techniques

1. The prolonged culture

Conventionally, IVF embryos or ICSI are transferred two to three days after the puncture. Using appropriate culture media, it is possible to prolong the in vitro culture of embryos up to 5 or 6 days after the puncture when the embryo transfer is done in the uterus. This is called “extended culture”, the resulting embryo is called a “blastocyst” and is at an advanced evolutionary stage.

This technique is proposed in addition to IVF or ICSI in case of repeated failure of implantation or to allow better selection of embryos in case of transfer of a single embryo. However, all embryos do not develop into a blastocyst. We must therefore have a minimum number of embryos on day 3 after the puncture to achieve prolonged culture.

2. Freezing embryos

When the remaining embryos after the transfer are good, they will be frozen for later use.

Currently, the freezing method is verification. It allows having better survival rate of embryos.

3. The freezing of gametes (eggs and sperm)

The freezing of oocytes :

It is through vitrification. Prior stimulation and oocyte retrieval as needed for IVF or ICSI. Oocyte freezing is indicated:

Before potentially sterilizing treatment (chemotherapy, radiotherapy …)

In case of the absence of the spouse’s sperm the day of the puncture.

Freezing of the sperm :

The collection of semen is by masturbation. After examination of the semen parameters, sperm is frozen for later use. Sometimes, testicular or epididymal sperm can be frozen. Sperm freezing is indicated:

• Before potentially sterilizing treatment (chemotherapy, radiotherapy …).
• If semen collection difficulties on the day of oocyte retrieval.

Azoospermia (absence of the ejaculate sperm) with samples of epididymal or testicular sperm.