ICSI procedure

Intracytoplasmic means that the sperm injection will take place inside the cytoplasm of the female egg. This is a gel-like substance present in the center of the female egg and is made up of salt, water, and other molecules.
ICSI is a specialized type of IVF (in-vitro fertilization) used to treat severe cases of male-factor infertility.

Symptoms

ICSI is generally recommended in the following male infertility cases:

• Low sperm count
• Poor quality of the sperms
• Anejaculation (an inability to ejaculate)
• Blockage in the male reproductive system
• Retrograde ejaculation (when the semen flows backward into the bladder)
• ICSI may also be needed in the following cases:
• Female supplying the eggs is more than 35 years old
• Traditional IVF has failed to create embryos
• Previously frozen eggs or sperm is being used for conceiving

Diagnosis

1. Blood tests: Underlying medical conditions in the male or female partner can be detected using these tests.
2. Semen analysis: Male fertility, along with the quality and quantity of sperm production in a man can be evaluated by a semen analysis.
3. Ovarian reserve testing: The quality and quantity of the female eggs can be evaluated using this test.
4. Vaginal ultrasound: This is a type of imaging test performed to obtain clear images of the female reproductive system.
5. Sonohysterography: The inside of the female uterus (womb) lining is checked by injecting a fluid through the cervix (the lower end of the uterus) into the uterus and then taking an ultrasound.
6. Hysteroscopy: The procedure involves inserting a thin, flexible, lighted telescope, known as a hysteroscope, through the female vagina and cervix into the uterus.
7. Infectious disease screening: The female and male partners are both screened to check for the presence of infectious diseases like HIV.

Treatment

The ICSI procedure is performed when the female egg is ready for retrieval. The ICSI treatment is performed in the following steps:

1. Retrieval:
The male partner will have to produce a sperm sample by ejaculating into a cup, or the male sperm may have to be retrieved surgically. Sometimes, the procedure may be performed earlier and the male sperm may be frozen for later use.
Multiple eggs are harvested from the ovaries of the female using a fine needle and an ultrasound probe under a mild anesthetic. Although this procedure is not painful, it may lead to slight bruising and soreness.

2. Injecting the sperm into the egg:
After retrieval, the semen sample from the man is washed and a single sperm will be isolated.
This sperm sample is then injected into a female egg using a very fine hollow needle. 
Since the sperm is injected directly into the egg, it does not need to swim through the cervical fluid of the female.
The sperm may take up to 24 hours to fertilize the egg and create an embryo.

3. Monitoring the embryo:
The fertilized embryos may be kept in the lab for up to six days.
During this period, the embryos will be monitored for signs of growth and development.
Not all fertilized embryos are transferred to the uterus of the woman. Only the healthiest and most viable embryos will be transferred.

4. Transfer of the embryos:
After the embryo has reached a particular stage of development, one or two embryos will be selected and transferred to the womb of a woman using an ultrasound-guided catheter. 
This could happen when the embryo is three days old and has eight cells, or on day five and is known as a blastocyst transfer.
If only one embryo is being transferred, known as elective single embryo transfer, having a blastocyst transfer can improve the possibility of having a successful, single, and healthy baby. 
If the treatment goes as per plan, an embryo will attach to the uterus wall of the woman and continue to grow to become a baby.

Risks

The following complications may be associated with ICSI in women:

1. Damage to the female eggs
2. Inability of the egg to fertilize following sperm injection
3. Embryo fails to develop in the lab or following embryo transfer
4. Increased risk of miscarriage 
5. The following complications may be associated with the baby born through an ICSI procedure:
6. Congenital (present at birth) defects
7. Intellectual problems
8. Autism (a neurodevelopmental disorder)
9. Hypospadias (a condition in which the urethra, which is a tube that carries the sperm and urine through the penis, fails to develop properly in the penis of the baby)
10. Low sperm count in male babies
11. Sex differentiation disorders
12. Angelman syndrome (a neurodevelopmental condition that primarily affects the nervous system of a person)
13. Beckwith-Wiedemann syndrome (a type of genetic disorder that affects the growth of a child and increases the risk of developing some types of childhood cancers)

After Procedure

1. The woman can resume most of her daily activities after embryo transfer.
2. It is normal for the woman to pass a small amount of bloody or clear fluid after the treatment procedure. 
3. It is normal to have mild bloating and cramping after the procedure.
4. The woman could have some constipation after the treatment.
5. Some women may experience some breast tenderness after the procedure.
6. If the woman experiences any pain following embryo transfer, the doctor should be contacted immediately.

Home-remedies:

The following home remedy tips can help in quicker recovery after ICSI treatment:

1. Avoid stress
2. Avoid or minimize caffeine intake
3. Avoid strenuous activities and heavy lifting
4. Avoid sex till complete healing occurs
5. Avoid hot baths
6. Avoid douching
7. Take all your prescribed medications, like folic acid supplements and prenatal vitamins, regularly 
8. Eat a healthy diet
9. Avoid alcohol and tobacco consumption
10. Take adequate rest, but not complete bed rest

Benefits:

ICSI may be associated with the following advantages:

1. Treatment of male infertility
2. Ability of a couple to conceive a genetic baby
3. Lesser chances of mental or physical defects in the child

Cost of ICSI treatment in India-

The cost of ICSI treatment in Mumbai is between INR 1,75,000 to INR 3,00,000.
The cost of ICSI treatment in Delhi is between INR 1,50,000 to INR 2,75,000.
The cost of ICSI treatment in Bangalore is between INR 1,50,000 to INR 2,75,000.
The cost of ICSI treatment in Chennai is between INR 1,25,000 to INR 2,50,000.