Modern assisted reproductive technologies help childless couples have their own children. In vitro fertilization (IVF) is a procedure involving the fusion of male and female sex cells outside the body with further placement of the embryo into the uterine cavity. ICSI (intracytoplasmic sperm injection) is a method that can be used during the embryological stage of IVF.

What are the stages involved in IVF?

In-vitro fertilization includes the following stages:

• Preparation (the couple is examined and prepared for IVF).
• A woman undergoes medication stimulation of superovulation. Follicle growth is monitored by ultrasound. Or IVF is performed in a natural cycle.
• Follicular fluid sampling with oocytes in it. The man donates his sperm.
• Embryological stage: a specialist washes the follicular liquid, extracts quality oocytes and normal mobile sperm from the sperm. The embryologist fertilizes the oocyte with a male germ cell in the laboratory. The oocytes are in a nutrient medium where the sperm cells are placed. Within two hours, the gametes fuse with each other independently.
• The resulting embryos (usually 1-2) are placed in the uterus.
• They are examined to see if they are pregnant.

The difference between IVF and ICSI is that during the embryological stage of ICSI, the doctor selects the best quality oocytes and injects pre-selected sperm (the best morphological parameters) into them. The sperm is injected directly into the cytoplasm of the oocyte by means of a micro-needle.

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After passing the ICSI procedure, the fertilization is successful in 60% of cases and the formation of embryos in 95%.

What are the indications for ICSI?

The ICSI is a more complex technique and is performed for the following indications:

• absence or low concentration of male germ cells in the semen;
• a high percentage of sperm cells with an abnormal structure;
• sedentary male sex cells;
• the acrosome in a sperm cell is absent or disturbed.

The difference between IVF and ICSI is only noticeable to the fertility doctor, for the spouses these two ART protocols are the same. The preparation for fertilization and the course of pregnancy in both cases are similar.

The choice of method is usually made in advance. But it may happen that IVF is planned, and the sperm obtained on the appointed day is of insufficient quality, then intracytoplasmic injection of selected sperm may be used. Sometimes couples decide to undergo ICSI immediately, but on the day of collection of the material it turns out that the sperm has a good chance of fertilizing the egg on its own.

As a rule, the choice of the method of ART is made by the couple together with the doctor, who gives a prognosis according to the results of tests and examinations. Preference is given to the method that has a higher probability of success in a particular case.