ICSI in Iran, Success Rates, and What to Expect


Introduction

Today, there are many methods for treating infertility, one of which is called ICSI. Like other fertility treatments, microinjection or ICSI increases the chance of having children in infertile couples by using sex cells with the highest qualities.

Such treatment aims to identify and select high-quality eggs and sperms for in vitro fertilization (IVF). For this purpose, the egg cell is first formed in the laboratory and then, it is transferred to the mother's uterus. It should be noted that the microinjection method is often used in cases where the cause of infertility relates to sperm problems such as its weakness or poor quality.

Of course, the most appropriate treatment method is selected after performing medical examinations and identifying the symptoms and causes of infertility.

icsi fertility treatment

What Is ICSI?

Microinjection or intracytoplasmic sperm injection (ICSI) is one of the newest assisted reproductive techniques (ART) in which the IVF technique is used. ICSI has been used in Belgium since 1992 and has shown promising results.

This method, which is now widely employed in Iran as well, is used when the sperm do not have enough speed and motility to reach and enter the egg. In this case, samples of male sperm and female eggs should be fertilized in the laboratory.

When Is ICSI Used?

ICSI method is usually used when the couple has severe infertility problems and the other methods of assisted reproduction have been unsuccessful. Normally, this technique is used when the male partner doesn’t have sufficient sperm or cannot produce sperm at all.  

In general, the conditions that lead to the use of ICSI in Iran include:

  • Low sperm count or oligozoospermia;
  • Absence of sperm in semen sample;
  • Improper and abnormal shape of the sperm;
  • Low motility of the sperm;
  • Having a vasectomy in the past;
  • When there is an urgent need to remove the epididymis or testes;
  • Injury or lack of vas deferens in a male partner;
  • Problems and failures in previous IVF treatment;
  • Having non-obstructive azoospermia or NOA (presence of sperm in testicular tissue and its absence in semen);
  • Ejaculation disorders in men with diabetes, spinal cord injury, etc.;
  • The necessity to use frozen sperm;
  • A small number of eggs in the female partner; and
  • Existence of some genetic disorders.


Who is a candidate for ICSI?

ICSI Treatment Procedure

After doing the initial examinations in Iran and choosing ICSI as a treatment, the following steps should be followed before the surgery: 

Ultrasound and ovulation induction

ultrasound should be done on the second or third day of menstruation. If it is prescribed by a doctor, the ovulation induction drugs (oral or injectable) should be taken for periods of 10 to 14 days. Also, five or six ultrasounds should be done during the use of ovulation induction drugs;

Egg collection

when the follicles have grown sufficiently, HCG is injected and the eggs are collected (through the egg retrieval process) from bulky ovaries under general or local anesthesia. At the same time, a sample of male semen is received and sent to the embryology laboratory;

Sperm collection

in this step, the sperms are washed to collect those that are healthy and highly active;

In vitro fertilization

36 hours after the injection of HCG to the female partner, the sperm is injected into an egg in the laboratory. Then, the egg cell is placed in the incubator to reach the four- and eight-cells stages;

icsi treatment procedure

Embryo transfer

72 hours after fertilization, a maximum of three or four embryos is transferred to the uterus by using laparoscopic or vaginal ultrasound methods. The embryos are transferred to the womb via a catheter which is a narrow and flexible laboratory tube. After about two hours, the mother is discharged from the hospital. 

In general, most stages of ICSI are similar to IVF steps and they only differ in the fertilization stage or in how the sperms are collected. In the ICSI method, if no sperm are observed in the semen, the surgical method is used. According to this method, techniques such as microscopic surgery (extraction of sperm with microscopic surgery under anesthesia) and testicular biopsy (tissue sampling of the testicles) can be used.

Also, after the mother is discharged from the hospital, an interval of 10 to 14 days is required for embryo implantation. Then, with the BHCG test, you can be sure of the success of the operation and the beginning of the pregnancy. In other words, the level of progesterone in the woman's body increases with the injection of the embryo and a blood test can confirm the continuation of the pregnancy. After that, the first ultrasound is performed in the seventh week of pregnancy.

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Understanding the fertilization Stage in ICSI 

In the ICSI method, fertilization or injection is an important stage that is done with the latest world technologies in Iran. At this stage, the cells around the egg are separated with special enzymes and then, the sperm is injected into the egg with special microscopic needles. After 24 hours, the egg is examined. If the fertilization process progresses properly, the cell will remain in the laboratory until it gets ready to be transferred to the uterus.

Sometimes a large number of embryos are produced through microinjection. In that case, some of them can be frozen for future pregnancies or even donated to other couples. Once the embryo is ready, it will be injected into the vagina by a catheter. This operation does not require anesthesia but sometimes, due to some problems, the doctor determines that laparoscopic surgery is a more appropriate option.

During this process, which is called ZIFT (zygote intrafallopian transfer), a certain number of embryos are transferred to the uterus based on the woman's age, the condition of the uterus, as well as the quality of the embryos. About two hours after the embryo transfer, the mother is discharged from the hospital and she is advised to rest at home for a few days.

Injection is an important stage in icsi treatment.

Problems in Sperm Collection during ICSI

It is noteworthy that the ICSI method is not 100% successful because it can be impeded for various reasons including problems in collecting sperm. In fact, before undergoing this treatment, it should be determined by tests whether the male sperm is suitable for fertilizing the egg and producing a sufficient number of embryos or not. After that, the possibility of producing sperm without the intervention of a doctor is determined.

If the male partner is unable to produce sperm, the sperm is collected from the epididymis (PESA method) or the testicles (TESA method). In some cases, testicular biopsy or sampling of testicular tissue (TESE method) has to be done.

Testicular Biopsy
Read more: Testicular Biopsy; A Way to Retrieve Sperm from Testicles

All About Frozen Embryo

In some cases, when the ovaries are inducted and the eggs are collected, more than one egg can be fertilized with sperm and thus excess embryos can be obtained. In such conditions, the couples can freeze the embryos in the fertility centers in Iran for future pregnancies and treatments.

Sometimes in the first egg retrieval process, problems such as vaginal bleeding during embryo transfer, excessive ovarian induction, uterine fibroids such as myomas and polyps, etc. are observed. If these problems occur, the doctor may recommend that the extra embryos get frozen so that they can be used in future pregnancies. By doing so, there is no need to re-induce the ovaries.

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Read more: Frozen Embryo Transfer: Timeline, Process & Tips

What Is the Difference between IVF and ICSI?

Despite many similarities, IVF and ICSI methods have differences, the most important of which is how the egg is fertilized by sperm. Of course, the main difference between these two methods with the IUI technique is the location of fertilization; in IUI, the sperm is injected into the fallopian tubes to make intrauterine fertilization. Thus, although the IUI method is simpler and less invasive, it is less successful.

The most suitable candidates for the IVF technique are women under 37 years old who have a BMI of less than 30 and an adequate ovarian reserve. However, it should be noted that this method is used for a wide range of infertility problems.

icsi ivf

According to the aforementioned conditions, the best candidates for microinjection are men with sperm problems. The most important sperm problems include abnormal shape, low number, low motility, and the need to collect sperm with surgery. ICSI can also be used in situations where the woman suffers from pelvic adhesions and closed fallopian tubes.

In general, the ICSI method is one of the final fertility treatments which is used in the case of failure in the IVF method and the impossibility of using the IUI technique. Due to the difference in the method of fertilization in these treatments, the chance of having twins in IVF is usually higher than in microinjection.

IVF In Iran
Read more: IVF Treatment, Process, and Conditions

Success Rate of ICSI in Iran

Statistics show that the success rate of IVF with microinjection and the success rate of IVF without microinjection is not significantly different and is about 30 to 40%; But so far, the effectiveness of ICSI in the treatment of many infertile couples has been proven so many times.

This fact has increased the validity of this method. This method usually fertilizes 70 to 85% of the eggs and is more successful than IVF in couples where the male partner is infertile. Of course, IVF is still an effective treatment method that is complementary to ICSI and in many cases, both of them are used together.

Fetal Sex Determination by ICSI in Iran

After fertilization in the laboratory, the sex of the embryo can be determined by microinjection and PGD; for doing so, a cell is taken from each embryo and its chromosome is identified. In this way, the desired gender of the embryo is transferred to the uterus of the mother. It should be noted that although the success chance of ICSI method is about 35 to 40% (as in other methods), it almost 100% determines the sex of the fetus.

Advantages of Microinjection Method 

Compared to other methods of assisted reproduction, microinjection has some extra advantages such as:

  • Possibility of using this method if there is even one healthy sperm in the male partner;
  • Possibility of using the method for women without fallopian tubes;
  • Suitable for treating men with severe fertility problems and the ones who don’t produce sperm at all; 
  • Suitable for using frozen eggs in fertilization, regardless of their changes after freezing; and
  • Higher chance of fertilization compared to IVF,
  • Dangerous Symptoms after Microinjection Surgery


If you notice any dangerous symptoms or problems after egg collection or embryo transfer, you should see your doctor immediately. These problems include:

  • Severe bleeding;
  • Continued dizziness and nausea after surgery;
  • Observing the symptoms of ovarian hyperstimulation syndrome;
  • Pain in the abdomen;
  • Short of breath;
  • Observing blood in the urine; and
  • Having a fever above 38 ° C.


Higher chance of fertilization is one of the advantages of microinjection.

Taking Medicine after Transferring Embryo

After transferring the embryo by the microinjection method, several medicines should be taken. The body needs progesterone to complete the implantation and pregnancy, reduce uterine contractions, as well as strengthen the lining of the uterus; thus, progesterone injection begins immediately after the embryo transfer. However, if you do not see any sign of pregnancy about 2 weeks after the transfer, you will stop taking this medicine.

Under any circumstances, the choice of the most appropriate method of fertility treatment should be made at the discretion of your doctor in Iran. Also, the chance of success as well as risk and complications of the treatment should be considered in advance. 

How Long Does ICSI Take in Iran?

In Iran, the length of treatment depends on several factors. Usually, the initial examination and ultrasound take about 2 weeks. After that, the course of drug administration until the transfer of the embryo lasts about 4 to 6 weeks, 2 weeks of which are related to the course of drug therapy. Sperm sampling and egg collection in the fertility centers of Iran also take about half a day.

After 2 to 5 days, the patient should go to the fertility center for transferring the embryo and 2 weeks after the end of the treatment, a pregnancy blood test or a Beta test should be performed to confirm the pregnancy.

Find the cost of IVF in Iran

Raadina Health, as a branch of Raadina Travel Co., provides the best services to the patients seeking to receive ICSI treatment in Iran. We support and help you to find easily the best fertility treatment centers in Iran as well as the right specialist for your needs. To book an appointment with a doctor, begin here.

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