ICSI Treatment in Lahore

In conventional IVF, thousands of prepared sperm are placed around each egg and one fertilizes it on its own. In ICSI, an embryologist selects one healthy-looking sperm under a high-powered microscope and injects it directly into the egg using a very fine glass needle.

Everything else in the cycle is the same as IVF: ovarian stimulation, egg retrieval, embryo culture and embryo transfer. The difference is only in how fertilization is achieved in the laboratory.

ICSI may be advised in situations such as:

• Severely low sperm count (oligozoospermia)
• Poor sperm movement (asthenozoospermia) or markedly abnormal shape (teratozoospermia)
• No sperm in the ejaculate (azoospermia), with sperm retrieved surgically from the epididymis or testis
• Previous IVF cycles with very low or failed fertilization
• Limited quantity of frozen sperm, or thawed frozen eggs
• Embryo genetic testing (PGT) cycles, to avoid contamination from extra sperm DNA
• Selected cases of antisperm antibodies or high sperm DNA damage

ICSI is not automatically better for everyone. In couples without a male-factor problem, studies have not shown that routine ICSI improves live birth rates over conventional IVF, and it adds cost and a laboratory step. Dr. Kamran recommends it when there is a clear reason.

1. Stimulation and egg retrieval

As in IVF, daily injections encourage several eggs to mature. They are collected under sedation with an ultrasound-guided needle.

2. Egg preparation

The surrounding cells are removed so the embryologist can check egg maturity. Only mature eggs can be injected.

3. Sperm selection

A sperm sample (fresh, frozen or surgically retrieved) is prepared, and the best-looking motile sperm is chosen for each egg.

4. Injection

One sperm is placed inside each mature egg. This takes only seconds per egg.

5. Fertilization check and embryo culture

Fertilization is checked the next day, 16 to 18 hours after injection. Fertilized eggs are grown as embryos for several days and graded.

6. Embryo transfer and pregnancy test

The best embryo is transferred to the uterus, and spare embryos can be frozen (see Frozen Embryo Transfer). A blood pregnancy test follows about 10 to 14 days later.

Even a few viable sperm can be enough for ICSI. When no sperm are found in the ejaculate, they may be retrieved by a short surgical procedure:

• PESA or TESA: needle aspiration of sperm from the epididymis or testis
• Micro-TESE: microsurgical sperm retrieval from the testis, mainly in non-obstructive azoospermia

Surgical retrieval is performed by an experienced urological surgeon and coordinated with your ICSI cycle. Dr. Kamran will explain whether this is likely to be needed after your tests; see our male infertility treatment page for the wider picture.

• Conventional IVF: eggs and prepared sperm are placed together and fertilize naturally in the dish. Suitable when sperm quality is adequate.
• ICSI: one sperm is injected into each mature egg. Used when sperm count, movement or shape make unaided fertilization unlikely, or when fertilization has failed before.
• Some centres split eggs between IVF and ICSI when it is unclear which will work, to avoid total fertilization failure.

Whichever is chosen, the stimulation, retrieval and transfer stages are the same. See the full IVF process for details.

ICSI mainly improves the chance that eggs fertilize. Whether that becomes a live birth depends on what happens afterwards, so the same factors that govern IVF success apply:

• The woman's age at egg collection, which remains the strongest factor
• The number and maturity of eggs retrieved
• Embryo quality and blastocyst development
• Sperm source (ejaculated or surgically retrieved) and sperm DNA quality
• Uterine receptivity

Fertilization failure is uncommon with ICSI but can still happen, for example if eggs are immature or sperm are unable to activate the egg. Dr. Kamran will give you an honest individual estimate and will not promise a result.

ICSI carries the usual IVF risks, such as ovarian hyperstimulation, multiple pregnancy and retrieval-related complications. It adds a small chance that an egg is damaged during injection.

Some studies report a slightly higher rate of certain birth defects after IVF and ICSI compared with natural conception. It is hard to separate the effect of the treatment from the underlying infertility, and the absolute risk remains low.

More importantly, severe male infertility can be linked to genetic causes, such as chromosomal changes or Y-chromosome microdeletions, which can be passed to sons. When sperm counts are very low or absent, genetic tests and counseling are discussed before ICSI.

Ask any clinic to itemize:

• The IVF cycle itself, including medication, monitoring and retrieval
• The ICSI laboratory fee, charged per cycle
• Surgical sperm retrieval, if needed
• Embryo freezing and storage
• Genetic testing, if recommended

You will receive an itemized estimate during your consultation, so you can compare before you commit.