ICSI ( 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 has now become the preferred method of achieving in vitro fertilization in our clinic. We achieve fertilization rates in excess of 85%, and can virtually guarantee embryo production with ICSI today. This reduces the risk of unexpected total fertilization 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 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 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.
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.
- Semen analysis for husband
- 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.
- HSG ( hysterosalpingogram) for wife
- Vaginal ultrasound scan for wife
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 cycle would be like.
Day 1. Inj Lupride , 0.2 ml sc. Email/ phone us you are starting
Day 2. Inj Lupride, 0.2 ml sc.
Day 3. Inj Lupride, 0.2 ml sc. Vaginal ultrasound scan and/or blood E2 level. Email/phone us with this report
Day 4 Inj Lupride 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 5 Inj Lupride 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 6 Inj Lupride 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 7 Inj Lupride 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 8 Inj Lupride 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 9 Inj Lupride 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 10. Come to Bombay/ Mumbai
If your personal doctor agrees to help, you can start your treatment locally and come directly on Day 10, so you will need to spend 10 days in 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.