Intracytoplasmic sperm injection has been the holy grail of an IVF laboratory. After its successful initiation in the early 1990s, the technique has had a massive impact on the industry. ICSI was all about addressing severe male infertility, but is now used routinely in a fertility clinic where ICSI has all but replaced IVF. Is too much ICSI harmful in the long term? Now, that is a matter of serious debate. However, ICSI is now one of the key techniques needed for an embryologist to grow. It’s a ticket to push it back to ancient times and mastering it is a challenge.

But unfortunately, due to the rapid acquisition of this skill, budding embryologists try to speed up their learning process. This results in a half-hearted approach that does not help to gain proficiency in ICSI.

ICSI procedure

To begin with, ICSI is a procedure in which a single sperm is injected into a mature oocyte with the help of a micromanipulator. At first glance, the procedure may require a week for basic training, but that may not prepare you to navigate through the overwhelming tides of regular case management and the unpredictable nature of the workload. The following steps can help overcome difficulties and result in thorough preparation for ICSI.

Meet the ICSI Micromanipulator

First of all, the fundamentals lie in thoroughly knowing the machine and the micromanipulator or microscope. It is as if you have to marry the machine to get used to every facet and aspect of its operation. Experience has taught that embryologists tend to overlook this essentiality. It is important to know about the condenser as well as the holding and injection pipette. Any type, be it RI or Narishige and even Eppendorf system, knowing the intricate details of the machine will be the foundation on which you can even tackle troubleshooting issues.

Second, the alignment part must be mastered. Here, people have been seen skipping certain steps which later become problems when you are about to immobilize sperm or inject oocytes. Practicing alignment seems boring, which makes people skip it or think it’s avoidable. This is the time when used needles should be brought in and used for aligning, as this will not only teach you how to align faster, but also make you realize that needles are very sensitive to handling and break. Details like setting the angle and changing the filter relative to the lens get drowned out in the middle of fine-tuning the alignment.

Preparing an ICSI plate a priority

Third, making an ICSI plate is also a priority. This will give you an idea of ​​the pattern you will incorporate along with the number of sperm that will be added in the PVP drop. I have seen inexperience flow when too many sperm are added in the PVP drop making it difficult to immobilize. Making a clean and clear dish along with adding an optimal amount of sperm is just as important as other steps.

sperm selection

sperm selection

Fourthly, the capture of sperm will continue. This step requires maximum practice and attention since the morphology of the chosen sperm is in your hands since there will be no choice regarding the oocytes. Initially, the sperm immobilization experience can be increasingly frustrating and this can entice trainees to jump into the oocyte injection part, which seems much easier and, yes, a bit glamorous. Basically you have to train your eye to pick the right sperm and the level of difficulty should increase with normozoospermia followed by severe OAT and even surgically removed samples. For beginners, the edge of a PVP sperm drop provides the necessary reservoir to start practicing sperm catching!

oocyte injection

oocyte injection

Finally, the injection of oocytes will be the final step. In this part, during the training, you may not get real oocytes and therefore you may lose the real feeling of injecting true mature eggs. The small suction applied to hold the ovum, the aspiration until a shaking sensation is obtained, the observation of a funnel-shaped structure in the cytoplasm will not be visible while immature oocytes are injected.

Read our tips and tricks for successful vitrification

Once you have combined all the steps and are confident, you need to start the process of trying to time and stimulate a real ICSI environment. In this scenario, the oocyte injections should start in this order. First, they must be degenerate eggs followed by unfertilized or M1 or GV. The latter may not indicate fertilization, but we can only check if they survive the injection process. This should be followed by the injection of two or three oocytes from a patient showing good quality oocytes and sperm. This must be followed by a progressive increase in the number of eggs with a corresponding increase in the level of difficulty. (say TESA/PESA cases) Here, you will be really exposed to different types and varieties of mature oocytes that you have to deal with. This should culminate in the delivery of half of the patient’s oocytes and then the entire patient under control or supervision. A record documentation of the destination of each injected mature ovum (fertilization or degeneration) and the technique applied (gentle or rough) together will ensure the confidence to engage said embryologist in routine ICSI procedures at the fertility clinic.

With the above steps, one should require around six months to routinely do ICSI with regard to the availability of resources. ICSI is like learning to drive a car. Training at a motor school will teach you the basics, but how you get acclimated to the roads and different terrain will depend on how you drive the car outside of school. Driving takes time to get used to, so this process above for learning ICSI will do the same for this technique.

At EART our goal is to offer the most advanced and competitive training worldwide in the field of ART. Our center, in addition to being optically equipped with state-of-the-art equipment, advises trainees at the hands of renowned embryologists, andrologists, biologists, reproductive endocrinologists and other experts in assisted reproduction techniques. Our individualized training program, since its inception in 2003, has to its credit trained more than 550 national and international candidates. A constant desire to move up the grade along with a motivated team spirit is EART’s goal of success.

Learn all about IVF lab equipment, embryology, culture medium, IVF techniques, advanced ART techniques, designing a new ART lab with experts at http://www.ivftraining.com