ICSI: procedures, opportunities, risks and costs
If men are the main cause of infertility, ICSI treatment is often the only chance of having a biological child. Intracytoplasmic sperm injection helps slow sperm cells on their way. Because with this fertility medicine method, the sperm is injected directly into the egg cell. We explain the details.
What does ICSI stand for?
Intracytoplasmic Sperm Injection (ICSI) is next to that IVF one of the most commonly performed treatments of the artificial insemination. This method, also known as microinsemination, is used when there are not enough fertilizable sperm or the sperm are too sluggish to actively fertilize an egg. The egg cells removed through a puncture of the ovaries are specifically fertilized with a single sperm under the microscope. If they develop further, they are transferred to the uterus. A pregnancy test 14 days later shows whether one or more embryos have successfully implanted there.
What is the difference to an IVF
The ICSI procedure is a further development of IVF treatment. The hormonal stimulation, the removal of the mature egg cells and the subsequent insertion of the embryos into the uterus are the same. The difference is in the method of fertilization. In in vitro fertilization, only male and female germ cells are brought together in a glass dish. However, the sperm must fertilize the egg cells independently. At ICSI, this act is carried out by a doctor. The sperm is injected directly into the egg cell in the IVF laboratory.
How does an ICSI work?
Semen analysis: The man’s sperm is examined under a special microscope. The sperm analysis shows how many sperm cells there are in the ejaculate, whether the sperm are motile, what shape they are and whether there are any infections. If too few sperm are available, sperm cells can also be obtained directly from the testicular tissue.
Hormonal stimulation: The stimulation of the ovaries through the administration of high-dose hormone preparations is usually carried out by women today. There are also easy-to-use disposable syringes, so-called pens, which already contain the necessary dose. Regular ultrasound examinations and blood tests are used to check whether and how many follicles are forming in the ovaries.
Puncture: The administration of another hormone artificially induces ovulation. In a surgical procedure, the mature egg cells are sucked out of the ovaries through the vagina with the help of an ultrasound probe. The puncture is usually done under a brief general anesthetic and on an outpatient basis. An average of 10 to 12 cells are collected.
Fertilization: Individual sperm cells are selected from the sperm cells obtained by masturbation or TESE (testicular sperm extraction). One sperm cell is then injected directly into an egg cell under a microscope. For this reason, the method is also called Intracytoplasmic Sperm Injection. If possible, more will be fertilized than will be used later, as it is unclear how many will evolve.
Transfer: If fertilization is successful and the egg cells continue to divide successfully, the resulting cells can be used two to three days later Embryos transferred to the uterus. The procedure is usually painless and takes place without anesthesia. Usually two are used for ISCI attempt to increase the success rate. After 14 days a pregnancy testwhether the transfer was successful.
What are the chances of success?
The ICSI method removes the greatest obstacle from the sperm’s way. It does not have to pierce the egg shell itself, but is given free passage through the injection directly into the female germ cell. But even if things rarely go wrong when injecting the sperm, the intracytoplasmic sperm injection harbors similar opportunities and risks as in-vitro fertilization. The pregnancy rate averages 20 percent. Whether ICSI is successful in individual cases and the woman becomes pregnant depends on a number of factors.
In addition to the age of the woman and the general state of health (diet, medication, weight, alcohol consumption) of the partner, the quality of the germ cells is of central importance for a pregnancy. If there are chromosomal abnormalities in the egg or sperm, even direct fertilization usually does not lead to success. In the next step, nature often ensures that the fertilized egg cell does not divide further in this case, not in the uterus nests or the mother loses the non-developing embryo through a miscarriage.
Couples who are considering an intracytoplasmic sperm injection should therefore inquire about the so-called baby take home rate (BTHR) in addition to the pregnancy rate at the fertility clinic. It provides information on the number of children born after artificial insemination. Here, too, it makes sense to look at the BTHR depending on the age of the woman in order to be able to realistically assess the prospects of becoming pregnant this way.
In the case of involuntary childlessness, ICSI is now the more frequently used method in Germany than IVF. In 2014 it was used in almost 75 percent of all artificial inseminations.
What are the requirements for treatment?
As with IVF, the age of the woman must be between 25 and 40 years and that of the man between 25 and 50 years. Both must be married or live together in a stable partnership (statutory health insurance only pays part of the costs for married couples). In addition, both partners must have a negative HIV test.
ICSI is usually carried out if IVF treatment was unsuccessful or if the preliminary examinations made it clear that the chances of having a child through in vitro fertilization are low.
Couples who want to have children and who prefer ICSI treatment instead of IVF at the first attempt because they hope to have a greater chance of having a child will often fail due to the requirements of the health insurance companies. Because the type of treatment indicated is not decided by the couple who want to have children. The statutory health insurance will only cover half of the treatment costs if there are a number of precisely defined medical reasons.
The Federal Joint Committee (G-BA) made up of doctors, psychotherapists, hospitals and health insurance companies will decide what these are. A new guideline has been in force since June 2017, which stipulates changes to the examination of male fertility prior to fertility treatment. That is new:
- If a 12-week interval between two spermiograms was previously required, this period is no longer applicable. The spermiograms must be made according to WHO guidelines.
- The doctor must be a serious male Fertility disorderdiagnose. No limit values are given for assessing the semen analysis.
- The examination by a urologist is no longer sufficient. Before creating a cost plan, an examination by a doctor with the additional designation andrologist is necessary.
It remains to be seen how the new directive will play out. On the one hand, the treating physicians had greater leeway in assessing the severity of male infertility. On the other hand, the need to visit an andrologist for couples who want to have children can lead to a time delay, as there are still relatively few doctors in this field in Germany.
What costs do the health insurers cover?
the In vitro fertilization costs push many childless couples to their financial pain limit. An ICSI treatment costs around 4000 euros per attempt. If more egg cells were obtained than were used in the first attempt, there will be costs for the Cryopreservation the germ cells for future experiments (between 300 and 500 euros).
The statutory health insurance companies usually pay 50 percent of the costs for a maximum of three attempts. Some health insurance companies advertise higher percentages or the assumption of more than three transfers. Here it is worth taking a closer look and comparing your own cash register with others. The costs that private health insurers assume varies from insurer to insurer.
In order for the health insurance to cover the costs, an application for the assumption of costs must be drawn up and approved. This so-called treatment plan is drawn up by the treating reproductive medicine specialist and then submitted to the health insurance company.
What risks do you have to expect?
The risks of ICSI treatment are largely identical to the possible side effects of other procedures artificial insemination.
Hormonal stimulation in women can lead to significant ovarian hyperfunction (ovarian hyperstimulation syndrome (OHSS)). If several embryos are introduced into the uterus, the natural risk of a multiple pregnancy increases (around 20 to 30 percent for IVF and ICSI). If pregnancy occurs after ICSI, it usually proceeds normally, even if there is a risk of one Miscarriage is slightly increased.
Many couples forget in advance that fertility treatment is not just a burden on the body. The whole situation is also a great burden for the soul and an acid test for many relationships. After the second or third unsuccessful attempt at the latest, it is time to talk about alternatives to fertility medicine. Also care or adoption can be the way to a dream child.
What happens to the excess germ cells?
Often more eggs are punctured during the first treatment than fertilized later. The surplus egg cells and sperm are frozen in liquid nitrogen with the consent of both men and women. The big advantage: If the woman does not become pregnant after the first time, no further hormone stimulation is necessary for the second transfer. However, not all women can benefit from cryopreservation, as it is not always possible to obtain enough fertilizable egg cells for multiple transfers.
What is the PICSI method?
The abbreviation stands for physiological ICSI and includes an extended preliminary examination of the sperm. While in normal ICSI attention is paid to the external shape, speed and mobility …