IVF and Advanced Fertility Treatment
Micromanipulation: ICSI, Oocyte Activation,
Assisted Hatching, and Fragment Removal
What is it?
Micromanipulation refers to the procedure which are performed using microscopic instruments to manipulate oocytes (eggs), sperm, and embryos. The goal of micromanipulation is to increase the chances of a successful IVF cycle. Such procedures include ICSI, oocyte activation, assisted hatching, and fragment removal.
How does it work?
ICSI
    Intracytoplasmic Sperm Injection (ICSI), is an alternative method of achieving egg fertilization, involving the direct injeciton of sperm into eggs obtained from in vitro fertilization (IVF). An extremely sharp glass needle is used to inject one normal appearing sperm directly into the center (cytoplasm) of the egg under the guidance of a specially fitted microscope.

    The procedure of ICSI includes the following:
  • The mature egg retrieved from IVF is held with a specialised pipette.
  • A very sharp glass needle is used to pick up a single sperm.
  • The sperm is injected into the cytoplasm.
  • The eggs are checked the following day for normal fertilization.
Assisted hatching (AH)
    Assisted hatching procedure includes the thinning of the protective outer membrane that surrounds the embryo, known as the zona pellucida. Since the normal aging process of a woman's eggs or the use of certain fertility medication may cause the membrane to thicken, the assisted hatching procedure may up the chances of implantation and successful pregnancy.

    The procedure of assisted hatching includes the following:
  • The embryo is placed under high magnification.
  • The laser is used to shave or thin the zona of the embryo.
  • The 'hatching' process, or the implantation of the embryo into the lining of the uterus is more likely
    to occur.
Fragment Removal
    The microsurgical fragment removal procedure is a technique designed to eliminate cellular fragments that interfere with the embryo development. It is an extension of the assisted hatching technique.
  • The procedure of fragment removal includes the following:
  • The embryo is placed under high magnification.
  • The hole is made in the zona and the glass needle is used to aspirate all or most of the fragments
    within the embryo.
  • Frament-free embryo will be replaced in the uterus.
When is it used?
ICSI
ICSI is most often used with couples who are dealing with male infertility factors.
Candidates for ICSI may include men with following conditions:
  • severely compromised sperm parameters, including low concentration, motility, morphology, or antisperm antibodies
  • blockage or absence of the vas deferens, where sperm is surgically collected by epididymal aspiration or testicular biopsy for ICS A hostile cervic condition
  • those who had low or failed fertilization on previous IVF attempts
  • unknown infertility (cause of couple's infertility remain unknown after completing all diagnostic testing)
  • certain medication or other medical history
Assisted hatching (AH)
  • Women over 38 years of age
  • With mild elevations in their day 3 FSH levels
  • Having repeated failures of ART cycles
  • With embryos that have abnormal appearing zona, as determined through close inspection by the embryologists
  • Thawed embryos with zona hardening