intracytoplasmic sperm injection(2)

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Page 1: Intracytoplasmic sperm injection(2)

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Intracytoplasmic sperm injection

Presented

by

Mian Numan

Mphil_AGB

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Key words

• (ICSI) Intracytoplasmic sperm injection• (IVF) in vitro fertilization

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contentsIntroductionWho might need ICSI.How is ICSI performed/stages of ICSI.couple Counselling.Benefits of ICSI.Fertilization and pregnancy success rates with ICSI Potential problems with ICSI. Alternative treatment options to IVF with ICSI. References .

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what is intracytoplasmic sperm injection (ICSI).

Intracytoplasmic sperm injection is a micromanipulation

technique used in the process of fertilization (IVF). It

involves injecting a single sperm in to the centre of a

mature oocyte under a microscope (i.e. injecting sperm

through the egg’s shell so that the sperm does not need

to penetrate the shell in order to fertilize the egg).

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(ICSI) differs from conventional (IVF).

Intracytoplasmic sperm injection (ICSI)

differs from conventional in vitro

fertilization (IVF) in that the embryologist

selects a single sperm to be injected

directly into an egg, instead of

fertilization taking place in a dish where

many sperm are placed near an egg.

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(IVF)

(ICSI)

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Who might need intracytoplasmic sperm injection?

• Couples experiencing the following infertility issues may benefit from intracytoplasmic sperm injection:I. Low numbers of sperm produced or ejaculated.II. Sperm that are abnormal. III. Problems with antibodies against sperm.IV. Testicular cancer.V. you are using frozen sperm in your treatment which is

not of optimum quality

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Low numbers of sperm produced or ejaculated

o this can be due to retrograde ejaculation or a

blockage in the vas deferens, the tubes that carry

sperm out of the testes. A complete absence of

sperm in the ejaculate can be overcome if there is

sperm production inside the testes. Sperm retrieval

methods are used to extract sperm surgically to

allow intracytoplasmic sperm injection to take place.8

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Sperm that are abnormal.

o Sperm that are abnormal and cannot swim well. Obtaining

plenty of sperm in normal ejaculate is straightforward and

intracytoplasmic sperm injection can overcome the problems

with getting these immobile sperm to meet up with the

woman’s eggs.

Problems with antibodies against sperm.o these can be produced by the male partner in the fluid of the

ejaculate, or by the female partner in cervical secretions.9

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Testicular cancer

occur in younger men and treatment may mean

that sperm production is affected. Sperm can

be frozen before cancer treatment (which has

a high success rate) and then the sperm can

be used for icsi.

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How is ICSI performed/stages of ICSI …

I. couple CounsellingII. Collection of spermIII. Collection of eggIV. Cleaning and dilution V. Intracytoplasmic sperm injection VI. Culturing of injected cells(16 to 20 hours)VII. Selection or separating of fertilized eggsVIII.Transferring to fresh medium (2 to 5 days)IX. (size 8 cells or more) X. implantation or Cryopreservation.

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couple Counselling

o All couples wishing to undergo (ICSI) should be counselled to the

commencement of treatment. Counselling should address any concerns the

couple may have also provide evidence based information regarding the

likely outcomes and what to expect while undergoing intracytoplasmic

sperm injection.

o Couples should also be aware that (ICSI) may fail, and be encouraged to

discuss alternative options (e.g. use of donor sperm, adoption). In addition,

couples undergoing (ICSI) should be aware of and discuss the increased risk

of congenital abnormalities, particularly in male offspring. 12

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Sperm collection

o fresh ejaculate but this is not possible in all male partners contributing sperm for intracytoplasmic sperm injection

o Men who cannot ejaculate because of nerve injury may be able to do so with electro-ejaculation.

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course of hormone treatment /Egg collection.

o first given a course of hormone treatment to stimulate her ovaries to produce several eggs.

o Monitoring of womano These are monitored using ultrasoundCollection of eggs once mature egg follicles have formed, the eggs are

collected using a thin tube passed through the vagina. The eggs are then placed in special culture fluid in the laboratory

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Sperm washing is a form of sperm preparation

that is required is for IVF, because it removes

chemicals from the semen, which may cause

adverse reactions in the uterus. During the

sperm washing process sperm is separated

from the seminal fluid. This procedure

enhances the fertilizing capacity of the sperm.

Cleaning and dilution

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Intracytoplasmic sperm injection

o The mature egg is held with a holding pipette.

o A very sharp and hollow needle is used to immobilize and pick up

a single sperm.

o This needle is then inserted through the zona (shell of the

egg) and in to the center (cytoplasm) of the egg.

o The sperm is injected in the cytoplasm and the needle is removed.

o The eggs are checked the next morning for evidence of normal

fertilization.

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Benefits of intracytoplasmic sperm injection

o ICSI enables fertilization to happen when there are very few

sperm available

o Before the development of intracytoplasmic sperm injection,

male infertility related to abnormal semen count was

considered largely untreatable. This assisted reproductive

technique has therefore enabled many couples who would not

previously have been able to conceive, or who would have

been reliant on donor sperm, to conceive a biological child.

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Fertilization and pregnancy success rates with ICSI

o Success is 35% in women aged 30 to 35, 20% at 35 to 40 and less than 10 % after 40. It is better to avail IVF before it is too late.

o Blastocyst embryo transfer at the 5–6 day stage, generally has higher success rates than embryo transfer at the 2–3 day stage.

o depending on the age of the couple, hormone levels, disease (Diabetes mellitus, hypertension, etc.) and lifestyle (excess weight, stress, alcohol and nicotine use, etc.)

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Fertilization and pregnancy success conti…

• IVF with ICSI success rates vary according to the

specifics of the individual case, the ICSI technique

used, the skill of the individual performing the

procedure, the overall quality of the laboratory, the

quality of the eggs, and the embryo transfer skills of

the infertility specialist physician.

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Fertilization and pregnancy success conti…

• In other words, the average egg quantity and quality

tends to be better in ICSI cases (male factor cases)

because it is less likely that there is a problem with the

eggs - as compared to cases with unexplained infertility.

Some unexplained cases have reduced egg quantity

and/or quality - which lowers the chances for a successful

IVF outcome.

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Rates of successful ICSI in vitro fertilization by season in a recent study

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Potential problems with intracytoplasmic sperm injection.

• The vast majority of children that are born as a result of

intracytoplasmic sperm injection are healthy but there is a

risk that if the father produces abnormal sperm, this may

be due to a genetic trait that is passed on to the child. It

may be possible to test for known genetic diseases

using pre-implantation genetic screening (PGS)but if there

is no obvious genetic abnormality, there is no test.

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Alternative treatment options to IVF with ICSI.

Intrauterine inseminations with the male

partner sperm. This involves sperm

processing in the lab, and then placement

of the processed sperm through the cervix

and up into the uterine cavity using a sterile

catheter by using a sterile catheter.

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References • NCBI (PUBMED )• Advanced Fertility Center of Chicago• Harley Street Fertility Clinic

London, United Kingdom

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Mian Numan kakakhelM.Phil research scholar NARC (national

agriculture research center Islamabad) pakistan

email : [email protected] #00923149223397

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