The ICSI procedure: looking into the past and future

ICSI is the most common ART technique currently in use and accounts for 70-80% of all cycles performed.

It was first started in 1990 to assist those couples with severe male factor infertility, who could not be helped by the conventional IVF.

And since the birth of first ICSI baby in 1992, the procedure is well standardized now, making it possible for substantial number of couples to have there own biological child instead of using a donor’s sperm . More than 95% of males can father their own genetic child due to ICSI.

This review published in the current issue of Journal of Human Reproduction Update provides the most recent knowledge on the technical aspects of many ICSI procedures to improve its competence. It reviews the most recent publications dealing with specific situations that may help embryologist to offer the best laboratory individualized treatment.

More than 1770 articles were found between January 1996 and March 2015, after going through PUBMED. Out of which 90 studies were related to the issues developed for female gametes and 55 for the issues developed for male gametes.

According to these studies:

• the injection of rescue metaphase I oocytes should be discouraged due to poor clinical outcomes and a high aneuploidy rates;
• laser-assisted ICSI represents an efficient method to solve the high oocyte degeneration rate;
• the optimal ICSI timing and the best polar body position during the injection have not been clarified;
• injected zona-free oocytes, if handled carefully, can develop up to blastocyst stage and implant;
• efficient options can be offered to patients who suffered fertilization failure in previous conventional ICSI cycles.
• Most debatable and inconclusive were the data on the method to select viable spermatozoa when only immotile spermatozoa are present in the sample.
• Till date, no data is available on reliable approach to filter out spermatozoa with fragmented DNA from the sample.

The drawback with this review was that most study did not report the final clinical outcome after the ICSI, which can establish the safety of a particular procedure.

Inspite of which the embryologist might benefit from the reviews and improve the outcome of ICSI.

References:

• Rubino P, Viganò P, Luddi A et al The ICSI procedure from past to future: a systematic review of the more controversial aspects Hum. Reprod. Update (March/April 2016) 22 (2): 194-227 first published online November 18, 2015 doi:10.1093/humupd/dmv050