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In vitro fertilization with intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection is used mainly when childlessness is caused by circumstances related to the male partner: when the number of sperm cells in the sperm is low or the mobility of sperm cells is poor. Microinjection is also used to collect sperm cells directly from the testicle or if in vitro fertilization has not resulted in fertilization of egg cells.

The treatment of the female partner follows the same procedure for ICSI-treatment as for IVF-treatment. The male partner provides a sperm sample on the same day as collection of egg cells takes place.  The sperm is processed, and the most mobile sperm cells are collected. Also, when sperm cells are retrieved directly from the testicle, this is done on the same day as collection of the egg cells.

Microinjection

Microinjection is a technique, where a sperm cell with maximum mobility is collected under microscopic inspection and introduced directly into the egg cell. The egg cells fertilized by microinjection are cultured under laboratory conditions in a cabinet designated for cell culture.  The conditions in the cabinet are optimized to correspond to the conditions prevailing in the female reproductive tract. Fertilization and the development of the embryos is followed for 2–5 days in the laboratory, after which the best embryo is selected for transfer to the uterus. In the laboratory, the remaining embryos of high quality are frozen for later use for embryo transfer.

The doctor and the couple decide on the number of embryos to be transferred to the uterus. Usually only one embryo is transferred to minimize the risk of a twin pregnancy; the maximum number of embryos transferred to the uterus is two.  Hormonal support continues still after the embryo transfer, and a pregnancy test may be carried out two weeks after the transfer. On average, 30–40% of transfers will end in a pregnancy.

Before in vitro fertilization with intracytoplasmic sperm injection is started, a treatment agreement is signed, as required by the Act on Assisted Fertility Treatments (1237/2006). In addition, a blood test is needed to exclude some infections (HIV, hepatitis B and hepatitis C).