One egg one sperm ICSI

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If you're undergoing ICSI, the embryologist gives the sperm a helping hand to enter the egg. Since it takes only one sperm to fertilise an egg, the embryologist catches a single sperm and injects it directly into the centre of an egg. If you have several eggs, the embryologist repeats the process.

ICSI sounds simple but is actually a very technically advanced procedure that requires complex equipment and a highly skilled operator. To perform the procedure, the embryologist uses a specialised piece of equipment called a micromanipulator, which has two 'arms' — one arm has a specially designed holding pipette (which has a slight suction applied to it) to hold onto the egg; and the other arm has an extremely thin, sharp and hollow needle attached to it to pick up and inject the sperm into the egg. The embryologist delicately steers the 'arms' using knobs and levers.

This is how the procedure works (see also Figure 7-1):

1. Using one of the micromanipulator's 'arms', the embryologist holds an egg still with the holding pipette.

2. The embryologist then steers the other micromanipulator 'arm' towards the chosen sperm and 'catches' it with the needle.

3. The embryologist steers the needle towards the surface of the egg and carefully pushes it through the shell of the egg into the centre of the egg, called the cytoplasm.

4. When the needle is in place, the sperm is injected into the cytoplasm.

5. The embryologist carefully removes the needle and returns the injected egg to the incubator.

These steps are repeated for all the eggs.

Optimising the environment

Over the next few days the newly introduced eggs and sperm are kept in dishes with culture medium in the incubator where hopefully embryos form during this time. The culture medium and the environment in the incubator closely mimic the conditions in the female body to give the embryos the best chance to form and develop. Embryos don't like changes in temperature or pH levels, so the embryologist makes sure that the eggs and sperm are removed only when absolutely necessary to check on progress and then for as short a time as possible.

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