Examining the reasons for ICSI failure

Intra Cytoplasmic Sperm Injection has been the centerpiece of all embryology activities in the IVF lab. The technique is known to have increased the rate of fertilization compared with conventional IVF and when the desired rate is not achieved, alarms will be raised. If the expected results are not gained, a lot of concerning questions will emerge which may create an environment of mistrust or blame game. If we examine the reasons carefully, a plausible solution can be found and a healthy working environment can be generated. If the numbers are dwindling, we can look into these following points from the embryologist side to understand poor outcomes.

Indicators of bad ICSI

 

1. Oocyte going into necrosis immediately after ICSI marked by central browning, swollen ooplasm, cytoplasmic degeneration.

 

2. Time taken for ten oocytes to be injected is more than 45 mins and all the oocytes were exposed to the outer environment simultaneously. (The best way to deal with this is to inject the oocytes in a batch of five to reduce exposure)

 

3. The fertilization rate and embryo formation are poor.

 

4. Pregnancy or implantation rates are less than conventional IVF and there is a drop of numbers connected to various parameters in donor cycles.

 

Read More: ICSI DISH PREPARATION

 

The following can be the causes of poor ICSI

 

1. Causes of oocyte damage.

 

2. Having a holding needle that is small, this may cause the oocytes to be pushed off in the injection procedure.

 

3. If the oocytes are held on the holding needle too tightly, the opposing membrane to the injection side becomes stretched and damaged. Gentle suction will avoid this situation.

 

4. Any injection that touches the opposing membrane will often result in degeneration and so stay away from it.

 

5. Movement of the injection needle in an up or down plane inside the oocyte will cause excessive damage.

 

6. Excessive aspiration of cytoplasm during sperm injection may result in degeneration or failure of the extrusion of the second polar body.

 

7. The vibration of the injection needle may cause damage. An anti-vibration table can be an option here.

 

8. Bad needle design can cause a problem.

 

Possible reasons for fertilization failure.

 

1. No breaking of the inner membrane.

 

2. Sperm not permanently immobile.

 

3. Sperm not sufficiently damaged.

 

4. Injection of an oocyte with the polar body misaligned causing damage to the metaphase spindle.

 

5. Sperm deposited in vesicles within the oocyte.

 

       Reasons for poor embryonic development. 

 

1. Bad microinjection technique owing to less practice or less exposure to handling actual oocytes.

 

2. Excessive time used for the injection which may result in an overall decrease in temperature.

 

3. Poor culture media or poor culture conditions.

 

4. Oocyte abnormalities. There is a comprehensive list of abnormalities that we observe whilst injection. Majorly, embryologists are more concerned about the speed rather than observations which can make them overlook these conditions. The next day when the fertilization rate is less, a lack of observations will create more doubts and questions.

 

These above points emphasize problems in ICSI and perhaps they can be recorded by simple observations when we are into the task. More focus has to be given on these intricacies rather than the competitive angle of how many oocytes are injected and etc! This will promote better comprehension of ICSI outcomes and help restore confidence or trust in the unit.

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