ICSI - Intra Cytoplasmic Sperm Injection

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The assisted fertilization treatments in which the process known as ICSI is used are the same as those in which plain in vitro fertilization is used, except for one thing: whereas in the latter procedure the sperm are placed in a laboratory container for them to swim to the oocyte and penetrate it by their own means, ICSI consists in injecting a sperm directly inside each oocyte and leaving them in a laboratory container for the fertilization to complete its process.

The rest of the stages, from the preparations prior to the fertilization to the embryo implantation, are the same in ICSI and in traditional in vitro fertilization and, in both cases, within 24 hours, the oocytes are examined to see if the first signs of fertilization have appeared: small spheres inside the oocyte, the male and female pronucleous.

ICSI is a procedure used when there are male deficiencies that result in the production of weak or too few sperm. In some severe cases, this deficiency is so significant that a single ejaculation is not enough for collecting the necessary number of sperm and it becomes necessary to collect the sperm that remains inside the testicles, in the vas deferens or in the epididymis. The sperm is collected by complementary procedures of puncture and suction.

This program offers the possibility to achieve pregnancy through the transfer of embryos obtained from the union of the donor's oocytes with sperm obtained from the husband, partner, or semen bank as the case may be.

The technique used in Worthymed program to achieve egg fertilization is called ICSI, and it involves the microinjection of a single sperm into an egg. This technique seeks to evaluate the maturity of the eggs to offer eggs which are apt for normal fertilization.

In addition, the injection of sperms makes the first step of the fertilization process easier. Once formed, the embryos are transferred to the recipient's uterus the second or third day following the microinjection.

Requirements to join the program as a recipient:
To be admitted into the program, recipients should not be older than 50.

Preparing the endometrial lining:
Once admitted into the Oocyte Donation Program, the recipient may start taking the medication necessary for the embryo transfer when her doctor deems it appropriate. The medication involves the administration of estrogens to make the endometrial lining highly receptive to the embryos.

The medication used for preparing the uterus depends on the presence or absence of ovarian activity in the recipient. If the patient is not menopausal, her cycle may interfere with the preparation of the uterus, and a medication (Lupron) is administered to suppress ovarian activity while the proceeding lasts.

If the patient is menopausal (she has not menstruated for more than a year) there is no ovarian activity and, thus, the only proceeding is the preparation of the endometrial lining (uterus lining where the embryos are implanted).

After the donor's follicle aspiration, at least four mature oocytes are set aside (Metaphase II). Afterwards, on that same day the oocytes are injected, and on the following day the fertilization is observed.

The embryos are transferred within 48 or 72 hrs. after the aspiration. The program has a strict policy limiting to two the number of embryos to be transferred to the recipient in each attempt. This decision seeks to diminish the incidence of multiple pregnancy - which is an undesired outcome in an assisted fertilization proceeding.

Applying this policy, the program's rate of global clinical pregnancy is close to 50%, based on statistics of 2004 and 2005, with a triple pregnancy incidence of 0%.

Embryo transfer is a simple proceeding involving no risks, the resulting discomfort is similar to that of a pap smear, and it lasts 15 minutes approx. Once the transfer has been completed, the patient must rest for 48hrs. Two days prior to the transfer, Micronized Progesterone is administered to the patient, and its administration continues up to the third month of pregnancy.