ICSI or Intracytoplasmic Sperm Injection is an advanced reproductive technique used for couples with severe male factor infertility. It involves the injection of a single, healthy sperm directly into the female egg. The fertilized embryo is then transferred directly into the woman’s uterus. The remaining steps of ICSI are similar to a typical IVF treatment cycle.
The success of the ICSI treatment depends upon a number of factors including the sperm quality, egg quality and the skill of the embryologist. One of the key reasons of failure of ICSI is fragile egg syndrome. As the name suggests, fragile egg syndrome refers to the weakness of the egg. The egg is fragile to the extent that it is unable to withstand the procedure. The chances of ICSI failure are high as the egg is most likely to be damaged or destroyed during it.
ICSI with Fragile Eggs
ICSI involves the puncturing of the cell membrane of the egg with a sharp, hollow needle. The elastic membrane is to be broken before introducing the sperm inside the cell’s cytoplasm. The procedure is to be done with great care and efficiency. The skill of the embryologist plays a considerable role in this regard. Even a minor error can cause the egg to be damaged and the resultant failure of the cycle.
The resilience of the egg membrane is important for the egg to be of a good quality. During ICSI, it is essential to break the membrane for the egg to be fertilized by the sperm. But fragile membrane can be responsible for death of the egg after ICSI. An egg with a very soft membrane is unable to withstand the pressure of the needle, however gently the embryologist applies it.
The biggest problem is that the egg might appear normal superficially but its fragility becomes evident only after ICSI is done. It may not die instantly but sometime after the procedure, when damage is already done. The patient may have invested a great deal on the cycle which would go futile. In many cases, this happens because the embryologist lacks the expertise to handle the egg and damages it while injecting the sperm. This means that the risk is high even if the egg is not fragile.
Research has been conducted to identify the risk factors of egg fragility. Women who are over 40 years old and have low AMH levels are prone to producing fewer eggs, most of them fragile. Eggs coming from follicles of smaller size (less than 10 mm) are usually fragile. Weak eggs translate to repeated failure of ICSI treatment cycles. Therefore, the problem is to be addressed as a part of the infertility treatment plan.
Handling Fragile Eggs
Once a woman is diagnosed with fragile egg syndrome, the infertility specialist handles her case in a different manner. Various options are available to carry out her treatment in an effective manner. She may be suggested to take up IVF treatment instead of ICSI as the former does not require mechanical manipulation of the egg. The risk of egg degeneration in IVF treatment is practically zero, as the sperm fertilizes the egg naturally. On the other hand, conventional IVF is not suitable for couples with very poor quality sperms. ICSI is the only option for such couples and the specialist has to think of some other alternative for them.
Egg fragility can be tackled by subjecting them to in vitro incubation before carrying out sperm injection. Once the eggs are retrieved, these have to be incubated for a few hours to make them stronger. The incubated eggs are cytoplasmically mature and the risk of damage during ICSI is minimized.
The ICSI technique may be slightly modified if egg fragility is suspected. Instead of injecting sperms into all the eggs together, the embryologist can first do it on a single egg. The egg should be carefully observed to check if anything goes wrong after the ICSI. In this way, the embryologist can handle the other eggs with precaution, instead of losing them all in one shot. Another measure that can be followed is not to aspirate the cytoplasm from a fragile egg before injecting the sperm into it. This, however, is extremely tricky because the sperm might be unable to penetrate the egg without aspiration of cytoplasm.
Handling fragile eggs can be the biggest challenge for an embryologist. But it is his skill, expertise and patience that can make the ICSI treatment a success despite this grave issue. The patients should therefore, rely only on the best IVF clinic to carry out infertility treatment for them.
Gaudium IVF is a reputed infertility clinic in Delhi where patients are given quality care at affordable cost. The clinic brings high-tech assisted reproductive techniques along with excellent gynecological care, all under one roof. Visit here to get a free second opinion from Dr. Manika Khanna, the award-winning IVF specialist in Delhi.