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ICSI ( ICSI Video ) ( pronounced "eek-see" ) stands for Intra
Cytoplasmic Sperm Injection, or microinjection) is the most
cost-effective treatment for male factor infertility, and allows us to
do in the IVF lab what is not happening normally in the bedroom, because
of a sperm problem. With ICSI, we can make the equation, one egg + one
sperm = one embryo, come true , no matter how low the sperm count ! Even
if the sperm count is zero ( azoospermia), we can recover sperm from the
testes ( using TESA or testicular sperm aspiration) or the epididymis
( using PESA, percutaneous epididymal sperm aspiration).
ICSI ( ICSI Video ) has now become the preferred method of
achieving in vitro fertilisation in our clinic. We achieve fertilisation
rates in excess of 85%, and can virtually guarantee embryo production
with ICSI today. This reduces the risk of unexpected total fertilisation
failure sometimes seen with IVF ( up to 29% of patients with
"unexplained " infertility with an apparently normal semen analysis may
have dysfunctional sperm which cannot fertilise the egg in vitro).
(Zona pellucida-induced acrosome reaction and failure
of in vitro fertilization in patients with unexplained infertility Liu
de Y, Baker HW. Fertil Steril 2003 Jan;79(1):74-80). ICSI ( ICSI Video ) also
allows us to generate more embryos
( permitting us to perform blastocyst transfer and offer
cryopreservation in more patients); and also allows us to assess oocyte
quality.
Want more information about
ICSI ?
Read the chapter on ICSI ( ICSI Video ) in our book, How to Have a Baby.
If you have done ICSI at another clinic, have you
got upset that a different doctor attended your procedures each time?
Are you forced to talk to a number of different nurses, with no real
direction ? Are you having trouble getting the feedback or explanations
you need ? At Malpani Infertility Clinic, all the treatment ( including
the consultation, all the ultrasound scans, egg collection and embryo
transfers are done personally by either Dr Anjali Malpani and Dr
Aniruddha Malpani). The buck stops with us - and we don't delegate any
part of your delicate and critical ICSI treatment to anyone else !
Our pregnancy rates are very high, because we can
transfer more embryos in difficult patients ( unlike clinics in UK and
Australia, where the number of embryos which can be transferred is
limited by law). While transferring more embryos does increase the risk
of high-order multiple pregnancies, this risk is negligible in difficult
patients ( for example, the older women or women with previous failed
IVF cycles). In our clinic, we customise the number of embryos we
transfer for each patient we treat, rather than just blindly follow a
guideline ( which has been laid down for the general population, without
considering each individual's specific problem).
Our equipment is state of the art and is sourced
from all over the world. For example, our CO2 incubators are Nuaire
incubators from USA; our stereozoom and inverted microscopes are from
Olympus, Japan, and our ultrasound scanner is from Aloka, Japan. We use
IVF catheters from Rocket of London, UK; ICSI pipettes from Cook,
Australia; the Saturn laser unit for laser assisted hatching and embryo
biopsy from Research Instruments, UK ; IVF culture medium from Vitrolife,
Scandinavia; and IVF disposables from Becton Dickinson, USA. Our IVF lab
complies with international
standards and guidelines.
Coming to Bombay (Mumbai) for ICSI is extremely easy
! Bombay (Mumbai) is a major metropolis, and has its own international
airport. The clinic is in the heart of south Bombay, and is an hour's
ride away from the airport. ICSI treatment is done on a day-care basis,
so you do not need hospitalisation at all. There are many
hotels nearby. You only need to make 4 -
6 visits to the clinic during the entire cycle, and after the embryo
transfer, you can fly back home !
This is the protocol we use for performing ICSI.
The following preliminary tests, to check the
quality of eggs, sperm, uterus and tubes, can be done locally with the
help of your gynecologist.
1. Semen analysis for husband
2. Blood tests for wife ( Day 3 - FSH, LH and PRL).
Specialty Ranbaxy Labs and
Metropolis Labs
both have a network of collection centers all over India, and
are very reliable.
3. HSG ( hysterosalpingogram) for wife
4. Vaginal ultrasound scan for wife
Please send us these reports to confirm they are
normal.
The actual ICSI treatment starts from Day 1 of your
cycle, when you start taking Inj Buserelin ( Suprefact, GnRH analog,
manufactured by Hoechst) , 0.5 ml subcutaneously daily. I vial contains
6 ml and will last for 12 days. Alternative options include Lupron ( for
patients from USA) or Nasarel or Synarel Spray; or Inj Decapeptyl Daily.
You then need to do a vaginal ultrasound scan or E2
( estradiol) blood level on Day 3.
Specialty Ranbaxy Labs and
Metropolis Labs
both have a network of collection centers all over India, and
are very reliable.You can do this locally in your own home town.
If the scan is normal ( no cysts in the ovaries,
with a thin endometrial lining) and / or E2 level is less than 50 pg/ml,
you start superovulation with HMG injections ( gonadotropins, Menogon ,
manufactured by Ferring ). Alternatives include other brands such as
Pergonal, Metrodin, Follistim or Gonal-F. Our standard dose is 3
ampuoles ( 225 IU) IM for patients less than 35 years of age; 2 ampuoles
( 150 IU) IM for patients with PCOD; and 4 ampuoles for patients more
than 35 years old.
This is what a typical treatment plan for an ICSI ( ICSI Video )
cycle would be like.
Day 1. Inj Buserelin, 0.5 ml sc. Email/ phone us you
are starting
Day 2. Inj Buserelin, 0.5 ml sc.
Day 3. Inj Buserelin, 0.5 ml sc. Vaginal ultrasound scan and/or blood E2
level. Email/phone us with this report
Day 4 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 5 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 6 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 7 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 8 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 9 Inj Buserelin, 0.5 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 10. Come to Bombay
You need to come to Bombay for a scan on Day 10; and
then do alternate day scans. Your husband only needs to join you on Day
14 for a day or so ( or you can hand carry his frozen sperm sample). To
do so, you need to borrow a
dry shipper from your local infertility clinic.
From Day 10 onwards, patients need to continue
taking daily injections, but are free to see the many delights Bombay
has to offer ! You can also take a 2-day trip to lounge around the sunny
beaches of Goa and/or see the famous Ajanta-Ellora caves.
We do not monitor E2 levels routinely, so you do not
need daily blood tests (we don't treat our patients as pin cushions!)
As a result of our simplified protocol, out of town
patients can start their superovulation in their own city, and need to
stay in Bombay for only 8-10 days. We also provide inexpensive
accommodation facilities for patients in the clinic itself. This is
especially useful when wives need to stay alone in Bombay. There are a
number of hotels nearby which offer
comfortable boarding and lodging as well.
You can book your tickets online, and find the best
deals by asking Indian
travel agents in your city. .A return air ticket to India from the
US costs about US $ 1000-1500. Your husband can accompany you, or you
can hand-carry his frozen sperm in a dry shipper ( which you will need
to borrow from your local infertility clinic).
If you have failed ICSI
in the past, we can use advanced technology to
maximise your chances of getting pregnant.
Selected patients can also qualify for
free ICSI treatment.
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