Intra Cytoplasmic Sperm Injection has been the holy grail of an IVF lab. After its successful initiation in the early 1990s, the technique has had a massive impact on the industry. ICSI was all about tackling severe male infertility but now it is routinely used in a fertility clinic where ICSI has almost replaced IVF. Is too much of ICSI detrimental in the long run? Now, that is a matter of serious debate. However, ICSI is now one of the key techniques necessary for an embryologist to grow. It is a ticket to push you into seniority and mastering the same is a challenge.
But, unfortunately, in the wake of quickly acquiring this skill, budding embryologists try to fast track their learning process. This results in a half-baked approach which doesn’t help in gaining proficiency in ICSI.
For starters, ICSI is a procedure where a single sperm is injected into a mature oocyte with the help of a micromanipulator. At the face of it, the procedure may require a week to get basically trained but that may not prepare you to sail through the overwhelming tides of handling regular cases and unpredictable nature of the load of work. The following steps can help overcome pitfalls and result in an exhaustive preparedness into ICSI.
Know The ICSI Micromanipulator
Firstly, the fundamentals lie in knowing the machine and the micromanipulator or the microscope thoroughly. It is like you ought to marry the machine in order to get accustomed to every facet and aspect of its working. The experience has taught that embryologists tend to bypass this essentiality. It is important to know about the condenser as much as it is important to know about the holding and the injecting pipette. Any type, whether it is RI or Narishige and even Eppendorf system, knowing intricate details of the machine will be the foundation on which you can even tackle troubleshooting issues.
Secondly, the alignment part is to be mastered. Here, it has been seen people skipping certain steps that snowball into problems later when you are about to immobilize sperms or inject oocytes. Practicing alignment comes across as boring which makes people skip it or think it’s avoidable. This is the time when used needles should be incorporated and used to align as this will not only teach you to do it faster but also will make you realize needles are so sensitive to handle and they break! Details such as setting the angle and changing the filter with respect to objective get drowned in the midst of hurrying the alignment.
Preparing ICSI dish a priority
Thirdly, making an ICSI dish is also a priority. This will give you an idea of the pattern you will incorporate along with the number of sperms to be added in the PVP droplet. I have seen inexperience flowing when too many sperms are added in the PVP drop which becomes difficult for immobilization. Making a clean and clear dish along with adding an optimum amount of sperm is equally important as other steps.
Selection Of Sperm
Selection Of Sperm
Fourthly, sperm catching will follow. This step requires the maximum practice and attention as the morphology of chosen sperm is in your hands considering there won’t be a choice with respect to oocytes. Initially, the experience of sperm immobilization may be increasingly frustrating and this may lure trainees to jump into oocyte injection part which seems much easy and yes a bit glamorous. Basically, you have to train your eye to choose the correct sperm and the difficulty level must increase with Normozoospermia followed by severe OAT and even surgically retrieved samples. For beginners, the edge of a PVP sperm drop provides the necessary reservoir to begin practice sperm catching!
Lastly, the Oocyte injection will be the final step. In this part, during training, you may not get actual oocytes and hence you may miss the actual feeling of injecting true mature eggs. The little suction to be applied for holding the egg, aspiration till you get a jerk like feeling, the observation of a funnel-shaped structure in the cytoplasm won’t be visible whilst injecting oocytes other than mature.
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Once you have combined all the steps and are confident, then the process of trying to time and stimulating a real ICSI environment must begin. In this scenario, the injections of oocytes should commence in this order. First, it should be degenerated eggs followed by unfertilized or M1s or GVs. The latter may not indicate fertilization, but we can just check if they survive the injection process. This should be followed by giving two or three oocytes to inject from a patient exhibiting good quality oocytes and sperms. This should be followed by a progressive increase in a number of eggs with a corresponding increase in the level of difficulty. (say to TESA/PESA cases) Here, you will actually get exposed to different types and varieties of mature oocytes you have to handle. This should culminate in giving half the oocytes of the patient and then the whole patient under monitoring or supervision. A documentation of recording the fate of every mature egg injected (fertilization or degeneration) and the technique applied (smooth or rough) together will ensure in giving confidence in absorbing the said embryologist in routine ICSI procedures in the fertility clinic.
With the above steps, one should require about six months for doing ICSI routinely with respect to the availability of resources. ICSI is like learning to drive a car. The training at a motor school will teach you the basics but how you acclimatize to roads and different terrains will depend upon how you handle the car outside the school. It takes time before you get used to driving and so this above process to learn ICSI will do the same for this technique.
At EART our aim is to offer the most advanced and globally competitive training in the field of ART. Our center besides being optically equipped with the state-of-art equipment’s, mentors the trainees by renowned embryologists, andrologists, biologists, reproductive endocrinologists and other experts in assisted reproductive techniques. Our individualized training program, since its inception in the year 2003, has to its credit of training 550 plus national and international candidates. A constant desire for up gradation coupled with motivated team spirit is EART’s goal to success.