ICSI ( ICSI
Video ) ( pronounced "eek-see" ) stands for
Intra Cytoplasmic Sperm Injection, or microinjection)
is the most cost-effective treatment for male factor infertility,
and allows us to do in the IVF lab what is not happening
normally in the bedroom, because of a sperm problem. With
ICSI, we can make the equation, one egg + one sperm =
one embryo, come true , no matter how low the sperm count
! Even if the sperm count is zero ( azoospermia), we can
recover sperm from the testes ( using TESA or testicular
sperm aspiration) or the epididymis
( using PESA, percutaneous epididymal sperm aspiration).
ICSI ( ICSI Video ) has now become the preferred method
of achieving in vitro fertilisation in our clinic. We
achieve fertilisation rates in excess of 85%, and can
virtually guarantee embryo production with ICSI today.
This reduces the risk of unexpected total fertilisation
failure sometimes seen with IVF ( up to 29% of patients
with "unexplained " infertility with an apparently
normal semen analysis may have dysfunctional sperm which
cannot fertilise the egg in vitro). (Zona pellucida-induced
acrosome reaction and failure of in vitro fertilization
in patients with unexplained infertility Liu de Y, Baker
HW. Fertil Steril 2003 Jan;79(1):74-80). ICSI ( ICSI
Video ) also allows us to generate more embryos
( permitting us to perform blastocyst transfer and offer
cryopreservation in more patients); and also allows
us to assess oocyte quality.
Want more information about ICSI ? Read the chapter
on ICSI ( ICSI Video ) in our book, How to Have a Baby.
If you have done ICSI at another clinic, have you got
upset that a different doctor attended your procedures
each time? Are you forced to talk to a number of different
nurses, with no real direction ? Are you having trouble
getting the feedback or explanations you need ? At Malpani
Infertility Clinic, all the treatment ( including the
consultation, all the ultrasound scans, egg collection
and embryo transfers are done personally by either Dr
Anjali Malpani and Dr Aniruddha Malpani). The buck stops
with us - and we don't delegate any part of your delicate
and critical ICSI treatment to anyone else !
Our pregnancy rates are very high, because we can transfer
more embryos in difficult patients ( unlike clinics
in UK and Australia, where the number of embryos which
can be transferred is limited by law). While transferring
more embryos does increase the risk of high-order multiple
pregnancies, this risk is negligible in difficult patients
( for example, the older women or women with previous
failed IVF cycles). In our clinic, we customise the
number of embryos we transfer for each patient we treat,
rather than just blindly follow a guideline ( which
has been laid down for the general population, without
considering each individual's specific problem).
Our equipment is state of the art and is sourced from
all over the world. For example, our CO2 incubators are
Nuaire incubators from USA; our stereozoom and inverted
microscopes are from Olympus, Japan, and our ultrasound
scanner is from Aloka, Japan. We use IVF catheters from
Rocket of London, UK; ICSI pipettes from Cook, Australia;
the Saturn laser unit for laser assisted hatching and
embryo biopsy from Research Instruments, UK ; IVF culture
medium from Vitrolife, Scandinavia; and IVF disposables
from Becton Dickinson, USA. Our IVF lab complies with
international
standards and guidelines.
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Coming to Bombay (Mumbai) for ICSI is extremely easy !
Bombay (Mumbai) is a major metropolis, and has its own
international airport. The clinic is in the heart of south
Bombay, and is an hour's ride away from the airport. ICSI
treatment is done on a day-care basis, so you do not need
hospitalisation at all. There are many
hotels nearby. You only need to make 4 - 6 visits
to the clinic during the entire cycle, and after the embryo
transfer, you can fly back home !
This is the protocol we use for performing ICSI.
The following preliminary tests, to check the quality
of eggs, sperm, uterus and tubes, can be done locally
with the help of your gynecologist.
This is the protocol we use for performing ICSI.
The following preliminary tests, to check the quality
of eggs, sperm, uterus and tubes, can be done locally
with the help of your gynecologist.
1. Semen analysis for husband
2. Blood tests for wife ( Day 3 - FSH, LH and PRL). Specialty
Ranbaxy Labs and Metropolis Labs both have a network
of collection centers all over India, and are very reliable.
3. HSG ( hysterosalpingogram) for wife
4. Vaginal ultrasound scan for wife
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Please send us these reports to
confirm they are normal. The actual ICSI treatment
starts from Day 1 of your cycle, when you start taking
Inj Buserelin ( Suprefact, GnRH analog, manufactured
by Hoechst) , 0.5 ml subcutaneously daily. I vial contains
6 ml and will last for 12 days. Alternative options
include Lupron ( for patients from USA) or Nasarel or
Synarel Spray; or Inj Decapeptyl Daily
You then need to do a vaginal ultrasound scan or E2
( estradiol) blood level on Day 3. Specialty Ranbaxy
Labs and Metropolis Labs both have a network of collection
centers all over India, and are very reliable.You can
do this locally in your own home town.
If the scan is normal ( no cysts in the ovaries, with
a thin endometrial lining) and / or E2 level is less
than 50 pg/ml, you start superovulation with HMG injections
( gonadotropins, Menogon , manufactured by Ferring ).
Alternatives include other brands such as Pergonal,
Metrodin, Follistim or Gonal-F. Our standard dose is
3 ampuoles ( 225 IU) IM for patients less than 35 years
of age; 2 ampuoles ( 150 IU) IM for patients with PCOD;
and 4 ampuoles for patients more than 35 years old.
This is what a typical treatment plan
for an ICSI (ICSI Video ) cycle would be like.
Day 1. Inj Buserelin, 0.5 ml sc. Email/ phone us you
are starting
Day 2. Inj Buserelin, 0.5 ml sc.
Day 3. Inj Buserelin, 0.5 ml sc. Vaginal ultrasound
scan and/or blood E2 level. Email/phone us with this
report
Day 4 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU),
4 amp IM
Day 5 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU),
4 amp IM
Day 6 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU),
4 amp IM
Day 7 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU),
4 amp IM
Day 8 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU),
4 amp IM
Day 9 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU),
4 amp IM
Day 10. Come to Bombay
You need to come to Bombay for a scan on Day 10; and
then do alternate day scans. Your husband only needs
to join you on Day 14 for a day or so ( or you can hand
carry his frozen sperm sample). To do so, you need to
borrow a dry shipper from your local infertility clinic.
From Day 10 onwards, patients need to continue taking
daily injections, but are free to see the many delights
Bombay has to offer ! You can also take a 2-day trip
to lounge around the sunny beaches of Goa and/or see
the famous Ajanta-Ellora caves.
We do not monitor E2 levels routinely, so you do not
need daily blood tests (we don't treat our patients
as pin cushions!)
As a result of our simplified protocol, out of town
patients can start their superovulation in their own
city, and need to stay in Bombay for only 8-10 days.
We also provide inexpensive accommodation facilities
for patients in the clinic itself. This is especially
useful when wives need to stay alone in Bombay. There
are a number of hotels nearby which offer comfortable
boarding and lodging as well.
If you have failed ICSI in the past, we can use advanced
technology to maximise your chances of getting pregnant. These options includes; laser assisted hatching; transferring more embryos; doing a blastocyst transfer; or doing a ZIFT.
Selected patients can also qualify for free ICSI treatment.
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