Intra-cytoplasmic sperm injection (ICSI)

Micro-surgical epididymal sperm aspiration (MESA)

Testicular sperm extraction (TESE) from a biopsy

The technique of intra-cytoplasmic sperm injection was developed at the University of Brussels in the Centre directed by Professor A.C. Van Steirteghem. Applied in humans for the first time in 1991-1992, this technique is now used in all the PMA Centres. It allows increasing the fertilization and pregnancy rates for couples with male factor infertility.

Performed with the use of micromanipulators under microscopic control, ICSI requires a long expertise. A mobile sperm with a normal morphological aspect is selected and immobilized by breaking its tail. A cluster of feeder cells, the cumulus-corona cells, which are removed before the sperm injection takes place, surrounds the oocyte. A glass holding pipette holds the oocyte. The injecting pipette, inside which a single sperm has been aspirated, is inserted into the oocyte. Once the egg membrane has been successfully broken, the sperm is slowly injected directly in the centre of the cytoplasm with as little fluid as possible. The pipette is then withdrawn and the oocyte closes its membrane.

Indications: severe infertility of masculine origin, previous failure of classic IVF

Microscope and micromanipulators used for ICSI

Images / sequence of an ICSI:

A. Sperm identification, B. Breaking of the tail, C. Aspiration of sperm inside the pipette, D. Oocyte held by a holding pipette and approached by the injecting pipette, E. Insertion of the pipette and breaking of the membrane, F. Sperm injected and pipette withdrawn.