What are the steps in underdoing ICSI? How long to prepare? It is a question that many couples need to know before deciding to do so. Today we will explain the steps for ICSI in detail for everyone to know.

ICSI (Intracytoplasmic sperm injection) is a high-end medical technology that helps couples with infertility to have children. ICSI is a method that is popular all over the world because it is a method that has a higher chance of success than other methods. And it also doesn’t take long to recuperate. The process of ICSI is an in vitro fertilization method that has been developed from IVF (In Vitro Fertilization), but it gives a higher percentage of success because IVF is a process of selecting perfect eggs and healthy germs to mix together to allow them to fertilize each other accordingly until becoming an embryo. Then it is brought back into the uterus.

Skilled scientists select the healthiest, most viable eggs and sperm. Then, using a delicate needle, they introduce the sperm right into the heart of the egg, its cytoplasm. This intimate union sets the stage for the creation of an embryo, which is subsequently nestled back into your uterus, giving that embryo a warm home to grow. ICSI significantly ups your odds of success compared to other methods.

Summary: What are the steps for ICSI?

Step 1: Ovarian Stimulation

Initially, before undergoing ICSI, it is necessary to have a test to see whether the body is ready to do ICSI or not, such as blood test and hormone measurement. For women, it is necessary to check during the day 2 and 3 of the menstrual cycle. This test is a method of evaluating ovarian function. Then there will be an ultrasound scan to count the number of eggs in that menstrual cycle before starting the injection to stimulate eggs in the abdominal area (the number of injections depends on the doctor’s diagnosis that it will be based on the amount of hormones, test results, and age of the woman for maximum efficiency.)

Injecting Eggs or Taking Medicines to Stimulate Eggs: Which One is Better?

The injected drug will be a drug that has the effect of stimulating the development and growth of several eggs at a time. This drug will take approximately 5 days to be injected and stimulated, then the development will begin. Getting an injection that has properties that will help delay ovulation before the scheduled egg collection time. During this time, the physician in charge will periodically measure hormone levels along with ultrasound to monitor the growth of the eggs to see how much they are and whether they are the right size for storage or not. The criteria for collecting eggs will depend on their size. The appropriate size is not less than 18 centimetres. If the appropriate size is found enough, the physician will start injecting the drug to stimulate ovulation within 36 hours.

Step 2: Egg Retrieval

In this process, it is not done through surgery as many people understand. But the medical team will collect it through the vagina (endoscopic surgery) by placing Anesthesia. Then the tool is a small needle attached to the ultrasound head gently insert and look for eggs before the eggs are extracted and cultured in egg culture solution to prepare for fertilization.

Step 3: ICSI Fertilization

On the egg retrieval day, if the patient uses fresh sperm, the man must come and collect sperm on this day or if uncomfortable, he can come and freeze the sperm before then. Scientists will thaw out sperm for use on the day the female eggs are collected.

In the process of collecting semen, the couples should abstain from sexual activity, including masturbation, for about 3-7 days. If one has complete sexual performance, they will use masturbation to ejaculate sperm into a sterile container. If one has sexual dysfunction problems, such as inability to get an erection, or infertility, in this case, the physician will use a method of collecting semen by taking a suction needle out through the testicle. The medical team will then take the semen to a laboratory to undergo a sperm screening process to select the most complete and healthy sperm. This step will take within 30 minutes to maintain the effectiveness of the semen as much as possible. And after selecting the sperm, food supplements will be added to increase the speed of movement at the time of fertilization.

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Normally, fertilization using GIFT, IVF, and IUI involves allowing the semen and egg to mix together. This can be done if the person has normal, healthy eggs and semen. But that method is not suitable for people with weak, incomplete semen and eggs with a hard shell so thick that sperm cannot enter. Therefore, ICSI treatment is more suitable because the physician in charge will use a small needle to suck up a certain amount of semen and inject it directly into the egg to achieve specific fertilization. Until the next embryo is born.

On egg collection day, scientists will conduct ICSI, which is called Day0.

Step 4: 5-to-6-days Embryo Culturing

After the Day0, the next day will be counted as Day1, which will know the results of how many embryos the ICSI procedure produced. The embryos will then be cultured. This step requires a team of doctors and experts to monitor closely because the temperature must be properly controlled to achieve maximum benefit in cell division. The longest culturing is 6 days or Day6, and then the embryos will be frozen. In some cases, it can be frozen from Day 2-3 as well (depending on the quality of the embryo). When each stage of cell division has occurred and is ready, the doctor will implant this embryo into the uterus to allow for further pregnancy.

Why is it necessary to use blastocyst-stage embryos for ICSI?

Step 5: Fresh Embryo Transfer into the Uterus

After 5-6 days or Blastocyst stage, if the embryos grow well and are strong, the doctor will make an appointment with the patient to transfer the selected embryos into the uterus.

But at present, if there is no problem or there is another necessary reason, Frozen embryo transfer is often used more than Fresh embryo transfer because it has a higher success rate.

Reasons why frozen embryo transfer has a higher success rate than fresh embryo transfer due to the side effects of stimulation that causes high hormones, edema or ovarian hyperstimulation syndrome (OHSS), and affects pregnancy. It may not be successful or if successful, the patient must bear the risk of OHSS remaining from stimulation.

During the embryo transfer process, women must relax and don’t be too tense or stressed because it will be an obstacle in embryo implantation. If one is easily stressed or easily worried person, the doctor will administer sleeping pills to make the embryo transfer go smoothly. The embryo transfer process is done by slowly using an embryo transfer tube. Inserted into the vagina, similar to a Per vaginal examination. It is passed through the cervix and the embryo is implanted in the most appropriate position in the uterus. This step may require an ultrasound to find the appropriate position and increase the chance of pregnancy.

Effects after ICSI Symptoms, effects after embryo implantation, and precautions that many people want to know.

Step 6: Embryo Freezing

If there are no issues or fresh embryo transfer is required, the physician will recommend freezing the embryos first to prepare the patient. This is due to the side effects of stimulation that causes high hormones, edema or ovarian hyperstimulation syndrome (OHSS), and affects pregnancy. It may not be successful or if successful, the patient must bear the risk of OHSS remaining from stimulation.

Embryo freezing is done after 5-6 days of embryo culturing or the Blastocyst stage.

Step 7: Uterine Wall Preparation

During this step, it will be a time for the patient to rest. So that the side effects from stimulation are reduced and prepare the uterine wall for further embryo transfer.

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Step 8: Frozen Embryo Transfer

After allowing the patient some time, the uterine wall has been prepared as much as possible. The doctor then makes an appointment for the patient to transfer the selected embryo back into the uterus.

In this step, the physician will take the frozen embryo and thaw it, then moves into the uterus. During the embryo transfer process, women must relax and don’t be too tense or stressed because it will be an obstacle in embryo implantation. If one is easily stressed or easily worried person, the doctor will administer sleeping pills to make the embryo transfer go smoothly. The embryo transfer process is done by slowly using an embryo transfer tube. Inserted into the vagina, similar to a Per vaginal examination. It is passed through the cervix and the embryo is implanted in the most appropriate position in the uterus. This step may require an ultrasound to find the appropriate position and increase the chance of pregnancy.

Fresh Embryo Transfer vs. Frozen Embryo Transfer: which is the most effective?

The advantages of frozen embryo transfer are there is time to prepare the uterus to be as ready as possible. It can also maximize the chances of a successful pregnancy with NGS chromosome testing. it is possible to detect chromosomal abnormalities including accurate screening of embryo quality. This will increase your chances of getting pregnant as well.

The chance of a successful pregnancy at Worldwide IVF can be as high as 85% from over 10,000 cases we have took care.

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Instructions After Embryo Transfer

• Avoid walking after embryo transfer for at least 30 minutes. In some cases, one may feel beat, pain in the abdomen, and dizziness. Therefore, avoid driving yourself. You should only have your husband, relatives, or close people bring you.
• Take medications into the vagina and take prescribed medication strictly and on time.
• Abstain from sexual intercourse in 14 days.
• Avoid vaginal douching.
• Avoid strenuous exercises or lifting heavy objects since there may be a risk of miscarriage.
• Consume nutritious food. The mother can eat normally but should focus on fiber-rich and easily digestible foods to prevent problems with constipation or diarrhea. These problems will result in an unsuccessful pregnancy.
• Avoid going to crowded areas or lots of people.
• Any abnormal symptoms must be informed to the physician.