Men with low sperm count were unable to have children with the conventional method of fertilisation (standard IVF). Nowadays, micromanipulation is a radical method of assisted reproduction. Micromanipulation is one of the most effective procedures to overcome male infertility and has helped numerous couples that suffer from male factor infertility since 1992. Micromanipulation may even help with very low sperm count, low sperm quality or with spermatozoa trapped within the testes. The success rates are as high as with standard IVF. Moreover, this method is very effective in cases where the sperm is unable to penetrate the oocyte membrane. ICSI may also prove beneficial to couples that have already had several unsuccessful attempts of standard IVF.
A couple that will decide to have an ICSI will follow the same protocol for ovarian stimulation as standard IVF up to the day of egg collection. The male partner will be asked to provide a sperm sample by masturbation in a quiet, private room. In cases of azoospermia, the spermatozoon is retrieved either from the epididimis with puncture (MESE) or, from the testes (TESE). Following careful sperm preparation, the best quality spermatozoon is chosen and injected in the cytoplasm of the oocyte. An electronic micromanipulator connected with an inverted microscope is used for this method. The oocyte is immobilised and with the use of an ICSI micropipette the spermatozoon is injected within the cytoplasm of the oocyte through the zona pellucida (membrane surrounding the oocyte). Once the ICSI micropipette is removed and the spermatozoon successfully placed within the oocyte, the zona pellucida seals back and the oocyte closes resuming its original shape. The fertilised oocytes are observed to determine normal division and growth until the day of embryo transfer. From this point on, procedure is similar to that of standard IVF.