A number of procedures performed under the microscope in order to improve fertilization of oocytes or the hatching of embryos. These procedures are performed in conjunction with IVF. They include ICSI and assisted hatching.

ICSI

In situations where sperm is scarce or unable to penetrate the eggs with conventional IVF, direct injection of individual sperm into the egg (intracytoplasmic sperm injection, ICSI) is practiced. It is performed as an addition to IVF. A very small glass needle is employed to aspirate individual sperm, which, under the microscope, is injected directly into the substance of the egg.

Indications:

The most common indications for ICSI are extremely low sperm count, poor sperm morphology (shape), poor sperm motion (motility) or failure to fertilize with conventional IVF.

Contraindications, complications, adverse effects:

An increase in chromosomal abnormalities and birth defects has been reported with ICSI, even though the larger studies do not show it to be statistically significant. One has to keep in mind that in males with very low sperm count, there is an increase in chromosomal abnormalities, especially those of the Y-chromosome, which may be passed on to the offsprings. Mechanical manipulation of the sperm and egg may cause damage to the egg and reduction in the number of fertilized eggs. ICSI has been performed successfully since 1992 and as such it is a relatively young technique whose safety has not been fully established. The consensus today, however, is that its benefits exceed its disadvantages.

Assisted Hatching

Assisted hatching is cutting or drilling a hole in the shell of the embryo to improve its hatching and implantation potential.