Treatment packages are mainly leveled based on the ranking of surgeons (according to the number of annual surgeries, years of experience, educational and experimental records, the rate of successful surgeries and the percentage of patients’ satisfaction) and the hospital/clinic where the surgery is performed.
About 10 to 15 percent of couples are infertile, and in most cases it is necessary to use assisted reproductive techniques (ARTs). There are many types of assisted reproduction techniques, starting with the simplest and most complex. It should be known that each couple has their own needs and the appropriate method of the same couple should be offered to them. Microinjection or ICSI is one of the infertility treatment methods with which a large number of couples today have been able to taste the sweet taste of motherhood and fatherhood.
Microinjection or ICSI stands for Intra Cytoplasmic Sperm Injection, which translates to intra-cytoplasmic sperm. ICSI and IVF, like IUI, are assisted reproductive techniques (ARTs), but unlike IUI, in which male sperm are inserted through a tube into a woman’s uterus, in IVF and ICSI, a female egg is combined with male sperm outside the body and in the laboratory. And after fertilization, the resulting fetus is placed inside the woman’s uterus.
The difference between IVF and ICSI is in how the egg is fertilized. In IVF, the sperm is exposed to the egg to enter the egg itself, while in ICSI, the sperm is inserted into the egg with a special needle. In order for the sperm to fertilize the egg, the sperm head must attach to the outside of the egg. When this happens, the sperm presses on the outer layer of the egg to enter the egg (cytoplasm), where fertilization takes place.
Sometimes for various reasons sperm can not penetrate the outer layer of the egg. Because either the outer layer of the egg is thick, or it is harder for the sperm to penetrate, or the sperm is not able to float and penetrate. In such cases, a procedure called injecting sperm into the cytoplasm, along with in vitro fertilization (IVF), is performed to help the egg fertilize. During this process, a sperm is injected directly into the cytoplasm of the egg.
The ICSI technique was first used in Belgium in 1992 to treat male infertility, and its success has revolutionized the treatment of male infertility. Especially in cases where it is not possible to perform intrauterine insemination (IUI) and in vitro fertilization (IVF) or the results of fertilization in previous IVF cycles have been negative; using this method can create new hopes in couples for success. This method is usually used in patients whose sperm are of low quality in number and shape.
The ICSI method is used in all cases where the conditions for the sperm to reach the egg in the uterus are not provided, such as the closure of the fallopian tubes, pelvic adhesions, low sperm count and low sperm motility. All infertility and infertility treatment centers hope that all couples undergoing in vitro fertilization will have successful and healthy children. However, the success rate of this method in the most advanced centers of the world is less than 40%. According to the results announced by the European Society of Embryology and Reproduction (ESHRE), the success rate in pregnancy in 2010 using the microinjection method was 1.32 percent. The success rate in the United States for each in vitro fertilization is as follows:
There are two ways to fertilize an egg with IVF: the traditional method and the ICSI method. In traditional IVF, 50,000 or more floating sperm are placed next to the egg in a laboratory container. Fertilization takes place when one of the sperm enters the cytoplasm of the egg. In ICSI, a sperm is injected into the center of an egg with a thin needle called a micropipette. In both traditional IVF or ICSI methods, when fertilization occurs, the fertilized egg (now called the sperm) continues to grow in the laboratory for one to five days before being transferred to the mother’s uterus.
After the relevant tests, hormonal tests and a couple visits by a specialist, if the microinjection method is suggested, the following steps should be followed:
In general, the ICSI operation can be divided into five stages:
Ovulation stimulants are often given over a period of 10 to 14 days. Drugs used for ovulation include superfect, human gonadotropin (HMG), follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH), and human placental gonadotropin (HCG). These drugs may be used alone or in combination. Ovulation stimulants are usually started from the first to the third day of the menstrual cycle according to the treatment plan, and from the sixth day, mature follicles are identified using serial ultrasound and daily blood tests. Finally, HCG is injected to fully mature the egg and release it. Ovulation will occur about 36 to 38 hours after the HCG injection. This allows the IVF team to determine the right time to pull or aspiration the egg (puncture operation).
A fertilized egg is called an embryo. The unicellular embryo begins to divide and a multicellular embryo develops. In both methods, the next morning, if fertilized, the embryos are incubated for another 24 hours to reach the four- to eight-cell stage and are ready to be transferred to the mother’s uterus. Embryo formation and their number and quality depend on the number and quality of eggs and sperm.
To increase the chances of pregnancy, more than one fetus is placed in the uterus, which sometimes leads to multiple births. The incidence of multiple births depends on the age of the mother (younger women are more likely to have multiple births) and the number of embryos transferred. In a woman between the ages of 20 and 29, with three transferred embryos, the chance of having multiple pregnancies is 46 percent.
In special cases where it is not possible to transfer the fetus vaginally or at the discretion of the doctor, the transfer of the fetus may be done with the help of laparoscopy, which is called ZIFT. Depending on the condition of the uterus, the age of the woman and the quality of the fetuses, an appropriate number of them (up to four fetuses) are transferred into the uterus.
The person is usually discharged from medical centers two hours after the transfer of the fetus. In most centers, people are advised not to do strenuous activity for three to four days after the operation, which leads to extreme fatigue, to have some relative rest at home, to refrain from strenuous activities, and preferably to use the toilet. 15 to 17 days after embryo transfer, the amount of HCG in the patient’s blood is measured, and an increase in this hormone is the first sign of pregnancy.
If the number of embryos formed is large (or in certain cases, such as the risk of overstimulation of the ovaries, vaginal bleeding during or before transplantation, or the presence of lesions such as polyps and myomas in the uterus that interfere with transplantation), at the discretion of the embryologist And the gynecologist, a number of embryos are frozen if the couple consents, and if there is a need to repeat the treatment cycle again, a number of frozen embryos are released from the freezing state and transferred to the mother’s uterus, and in subsequent periods of treatment, the process Ovarian stimulation and egg collection will be eliminated.
The patient is usually discharged one to two hours after the embryo is transferred to the uterus. The patient should avoid strenuous activity for two to four days and rest. It is also very important for the patient to have peace of mind and be away from anxiety and it is effective in the success of the operation. After 10 to 12 days, the patient should see a doctor for hormonal tests to measure the BHCG level in his blood. An increase in this hormone is one of the first signs of pregnancy.
Progesterone plays an important role in implantation of the fetus in the uterus and the continuation of pregnancy. On the one hand, this hormone strengthens the layers of the uterus and on the other hand, it reduces uterine contractions. Therefore, progesterone injection and the use of vaginal suppositories should be continued regularly, with a doctor’s prescription during pregnancy. After the second pregnancy test, if you are completely sure of the absence of pregnancy, it is necessary to stop taking it with a doctor’s order.
In microinjection method, more than 70% of fertility is done in eggs. Also, according to reports and pregnancy rates, this method has been reported more than IVF.
If your partner is not able to ejaculate or the sperm collection conditions in IVF are not suitable, sperm can be easily extracted from the testicles by microinjection method. If a woman does not have fallopian tubes, microinjection is one of the best methods. Microinjection is used to help couples with infertility of unknown cause.
With all these benefits of microinjection, doctors still recommend IVF infertility because the chances of getting pregnant with microinjection are very similar to those with IVF. Only IVF is shorter and simpler than microinjection. The microinjection method was newer than IVF.
When we talk about the benefits of a treatment method and even about the benefits of a product, we should definitely mention its disadvantages so that we can choose that treatment method safely.
The cost of microinjection (ICSI) depends on many factors, including the doctor’s education and expertise, the clinic where the treatment is performed, and the number of times microinjection is performed. In general, the cost of infertility treatment in Iran is lower than other countries in the world. The cost of infertility treatment is divided into three parts: the cost of medicine, the cost of infertility treatment diagnostic procedures such as the cost of ultrasound, frequent visits, laboratory and… as well as the cost of the operating room. Also, the cost of the operation will increase if the couple needs a donated egg.
It should be noted that individual brochures based on the patient / client plan, including pre- and post-operative instructions, as well as the necessary information and processes for further follow-up are provided to you. During your stay in Iran, the experts and translators of Nora Health Tour fully support you 24/7 and will happily help you to resolve any concerns or ambiguities that may arise for you.
It should be noted that individual brochures based on the patient / client plan, including pre- and post-operative instructions, as well as the necessary information and processes for further follow-up are provided to you. During your stay in Iran, the translators of Nora Health Tour fully support you 24/7 and will happily help you to resolve any concerns or ambiguities that may arise for you.
If a mother becomes pregnant naturally, the chance of birth defects for her baby is 1.5 to 3 percent. The chance of giving birth to a baby is the same as birth defects in IVF and ICSI, but it is relatively higher than in a normal pregnancy. The relative chance of birth defects is actually due to the underlying problems of infertility, not due to infertility treatment.
There are certain problems with ICSI, such as Beckwith-Wiedmann Syndrome, Angell Mann Syndrome, Hypospadias, or sex chromosome disorders. These disorders occur in less than 1% of babies born with this method. Some infertility problems may be genetic. For example, boys born by microinjection may have the same infertility disorders as their father.
This method is recommended for people with the following conditions:
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