Intracytoplasmic sperm injection

The Intracytoplasmic sperm injection, ICSI is a method of artificial insemination. The sperm, the sperm of the man directly into the cytoplasm ( ooplasm ) is injected an egg. A failure of fertilization can be nearly impossible.

The ICSI usually applies if previous in- vitro fertilization attempts were unsuccessful or the man has poor sperm quality. If no sperm in the ejaculate may be present, there is the possibility to win them by means of microsurgical measures of testicular or epididymal tissue and used for ICSI.

Morphological sperm selection

Intracytoplasmic morphologically selected sperm injection (IMSI ) is a development of ICSI. The sperm are at 6000facher magnification (ICSI = 400-fold ) were analyzed and selected for injection into the oocyte. This method is used especially for patients after failed ICSI attempts.

Discussion

The ICSI method is discussed based on different viewpoints. The most common point of discussion is that through direct intervention in nature the complex interrelations and the biological selection between sperm and the egg is overridden ( for example, avoiding the development of embryos with genetic diseases ). A rate of major malformations has not yet been conclusively proven. However, study data indicate a relationship between infertility treatment and the rate of congenital malformations, where previously it was unclear whether it is due to the treatment or the disorder itself. Comparatively rare - - In the literature, for example, the first indications of an increased incidence of in recent years syndromes have emerged, such as Beckwith -Wiedemann syndrome, Angelman syndrome, Prader -Willi syndrome. All of these syndromes are associated with epigenetic phenomena such as imprinting or ( unusually ) DNA methylation of genes. In some cases, an ICSI lead to Digynie, sets of chromosomes are present in two maternal (maternal ) together with a paternal ( fatherly ) set of chromosomes in a zygote. The fetus then has a type II triploidy

Pending a final determination of that issue for some time will pass, because the syndromes are relatively rare. These potential problems of ICSI, however, gain importance in the future, since practically every pre-implantation diagnosis, which is banned in German-speaking countries at the time, this method is in use to allow the genetic analysis by PCR or in situ hybridization, since the time of fertilization must be known precisely in order to comply with the time frame of the investigation can.

Currently in Germany three ICSI attempts are half of the public health insurance eligible ( formerly four, 100 %). However, this applies only to married couples, unmarried need the cost ( total from about 5000, - € upwards) contribute to 100 % yourself. There are recommendations of the Ethics Committee, 1990 to adjust the Embryo Protection Act to the new techniques. Common practice is currently to be found in the woman after hormone stimulation and several eggs to fertilize with the sperm of a man. Because currently, may, in contrast to other countries, in Germany not make a selection of the fertilized oocytes after its development the embryo, are then used by most only three days to three embryos into the uterus, the rest of the fertilized eggs will be frozen for later attempts or discarded. The problem here is that after 3 days in most cases, no so-called blastocyst has been created yet, the better chance of implantation it is hoped; this stage is reached only after about 5 days.

According to a press release by the European Society of Human Reproduction and Embryology ( ESHRE ) in July 2008, the ICSI is used too often in Europe. Pairs without pronounced male infertility, ICSI does not promise better chances of getting pregnant than the In Vitro Fertilisation (IVF). In addition, ICSI is complicated and expensive. In Germany, health insurance must bear the cost of artificial insemination by ICSI only if certain specified limits are met.