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Micromanipulation Technique Helps Infertile Couples | |
By DR. JAMES A. GRIFO A new technique called intracytoplasmic sperm injection is offering hope for couples who cannot achieve pregnancy because the would-be father has an extremely low sperm count. ICSI, as it is abbreviated, is complex and expensive. But it can work when other advanced techniques have failed. ICSI can be regarded as an extension of in vitro fertilization (IVF), in which an egg is obtained from a woman, fertilized outside the body and implanted in the womb. ICSI is used in patients who have fertilization failure with traditional IVF techniques or when the male has too few sperm to perform IVF. The technique was originated in Belgium in 1992 by Dr. Gianpero Palermo. He brought it with him when he came to the United States in 1993. It now is performed at a number of centers. ICSI begins when several eggs are obtained from the woman. Sperm is recovered from semen or sometimes by surgery or testicular biopsy. This step is one feature that distinguishes ICSI from in vitro fertilization, which can fail if too few sperm are present in the laboratory dish where fertilization is to occur. The crucial difference in ICSI is the actual fertilization of the woman's eggs in the laboratory. A single sperm is injected into each egg cell. The fertilized egg or eggs then are allowed to divide several times before several eight-cell embryos are implanted in the uterus. The implantation usually is done after three days, which allows for several cell divisions. If a first implantation fails, a second can be done, using frozen embryos. The rate of success, as reported by a number of centers, depends on age. It can be over 50 percent for women under 40 but drops under 25 percent for women over 40. In all, several thousand ICSI procedures have been done in the United States and Europe. The cost usually is in the neighborhood of $10,000. Some medical insurers will pay for the procedure, but most will not. Information about centers that do ICSI can be obtained from Resolve, a patient-formed organization for fertility assistance or from the American Society for Reproductive Medicine. Resolve has chapters in a number of cities. The telephone number of its national headquarters in Boston is (617) 623-1156. --- Dr. James A. Grifo is Associate Professor and Director of the Division of Reproductive Endocrinology at New York University Medical Center. Copyright 1996 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. | |