Diagnosis of ICSI Treatment

Introduction

Many couples find infertility to be a physically and emotionally draining experience. Intracytoplasmic sperm Injection (ICSI), is a targeted and highly advanced treatment option, particularly in cases of Male Factor Infertility. ICSI, however, is not the perfect solution for everyone. To determine if ICSI is the right method, fertility specialists should conduct a comprehensive diagnostic evaluation on both partners.

ICSI diagnosis involves a combination medical history, physical exams, hormonal studies and imaging tests. All of these are aimed at identifying infertility’s root cause and determining if ICSI is an appropriate treatment. This article will examine the diagnostic process leading to ICSI.

Diagnosis of ICSI Treatment

Comprehensive Medical History

First, both partners must provide a medical history. It’s not just a formality, but it lays the groundwork for further investigations. The fertility specialist may ask about your infertility duration, the frequency of your sexual activity, previous pregnancies, miscarriages and lifestyle (smoking or alcohol use, exposure to heat, chemicals or other substances at work, etc.) as well as any health conditions you have, such as diabetes, thyroid disorders or infections.

Men will be asked about their sexual function and any problems with ejaculation.

This phase determines whether any external factors or hormones may be affecting fertility. It also highlights the likelihood that male or female infertility is the cause. The evaluation continues with more focused investigations if male factor infertility has been suspected.

Semen Analysis as a Core Diagnostic Tool

The Semen Analysis is one of the Most Critical Steps to diagnose the need for ICSI. This test is a laboratory evaluation of the sperm parameters to determine their ability for natural fertilization and conventional IVF.

Standard semen analyses assess the following factors:

• Sperm concentration :- Number of sperm in milliliters of semen. A normal count is over 15 millions/ml.

• Motility :- Ability of sperms to move efficiently and actively. At least 40% should be able to move.

• Morphology Shape and structure of the sperm :- According to the strict Kruger criteria, at least 4% of all sperms should be normal-shaped.

• Volume & liquefaction :- Total amount of semen & how it liquefies following ejaculation.

• White blood cell count and pH: Both can indicate inflammation or infection.

If the semen parameters show significant abnormalities–such as a low count (oligospermia), poor motility (asthenozoospermia), or abnormal morphology (teratozoospermia)–then conventional IVF may not be successful, and ICSI is typically recommended to increase the chance of fertilization.

Hormonal testing

Hormones are important for both men and woman’s reproductive health. Blood tests are performed to determine hormone levels when sperm or eggs are suspected.

The following hormones can be tested in men:

• FSH (Follicle-Stimulating Hormone) :- High FSH may indicate testicular failure or poor sperm production.

• LH (Luteinizing Hormone) :- Helps stimulate testosterone production.

• Testosterone :- A key male hormone; low levels of this hormone can affect sperm production.

• Estradiol and Prolactin :- Elevated concentrations may interfere with testicular functions.

These markers can be used to identify endocrine disorders and determine if they are treatable or if advanced fertility techniques such as ICSI is required.

The hormonal assessment of women includes:

• Anti-Mullerian hormone (AMH) :- Indicates ovarian reserves or the number of eggs remaining. A low AMH can indicate reduced fertility.

• FSH & LH :- Both are important in assessing a hen’s ability to mature eggs.

• Estradiol & Progesterone :- Give insight into menstrual cycles regulation and ovulation.

• TSH & Prolactin :- Help diagnose thyroid or pituitary disorders that can disrupt ovulation.

The number of eggs and the quality can be affected by a woman’s low ovarian reserve, or irregular ovulation.

Genetic Test

Genetic Testing is recommended in certain situations before ICSI. This is especially true if you:

• The semen analysis shows a complete absence of sperm (azoospermia).

• The male partner is a with a family history of genetic disorders or birth defects .

• ICSI is being repeated despite repeated failures.

Genetic tests are most commonly used to:

• Karyotyping :-  To detect chromosomal abnormalities like Klinefelter syndrome.

• Microdeletion of the Y Chromosome Test :- To detect missing regions that can affect sperm formation.

• CFTR gene testing :- Especially men with congenital lack of the vas Deferens (a disorder linked to cystic fibrosis genes mutations).

preimplantation genetic testing may be recommended to test embryos during ICSI in order to prevent genetic disorders from being passed on.

Imaging with Ultrasound

Sometimes imaging studies are needed to explore structural causes of fertility.

A scrotal ultrasonography can be done on men to check for:

• Varicocele

• Obstructions of the vas deferens

• Tumors or abnormalities of the testicle

In women, a transvaginal ultrasound and HSG (Hysterosalpingography) may be used to assess:

• The size of the ovary and egg follicles

• The presence of fibroids or cysts in the ovary

• Uterine abnormalities

• Blockage or damage to the fallopian tubes

ICSI does not require tubal function. However, the health of uterine and/or ovarian tissues is still important for successful embryo implantation.

Evaluation prior IVF or Fertilization Failed

After a failed IVF cycle , many couples are at the ICSI stage. Doctors re-examine previous cycles’ outcomes in such cases.

• The number of eggs recovered

• The quality of the eggs and embryos

• Fertilization rate

• The IVF dish and Sperm Performance

• Any issues during embryo transfer

ICSI can be recommended for the next cycle if the multiple mature eggs did not fertilize, or if the embryo development was poor. This will increase the chances of fertilization and allow a more precise control.

Conclusion

ICSI isn’t always the first treatment. Some couples are able to conceive by themselves or using basic fertility treatments such as ovulation stimulation or intrauterine sperm injection (IUI). ICSI can be a good option when the test results indicate severe to moderate male infertility or previous IVF cycles failed.

ICSI diagnosis is not based on a single test. It is a multilayered, step by step evaluation which takes into account sperm quality, hormonal balance, genetic risk, and the overall reproductive potential. The diagnostic process is carefully designed to ensure that couples get customized, effective treatment and the best chance of success.