Tests Required Before Intracytoplasmic Sperm Injection (ICSI)
During the journey of treating delayed conception and undergoing Intracytoplasmic Sperm Injection (ICSI), both partners need to undergo several tests before the procedure to increase the chances of success. Follow this article to learn about the tests required before ICSI.
What is Intracytoplasmic Sperm Injection (ICSI)?
Intracytoplasmic Sperm Injection (ICSI) is one of the methods to treat delayed conception and infertility. During it, a single healthy sperm is injected directly into a mature egg to ensure fertilization. ICSI is often used when there are problems with semen quality, such as low sperm count, poor sperm motility, or when the woman produces few eggs.
Tests Required Before ICSI
It is important for both partners to be in good health before pregnancy to increase the chances of ICSI success and a healthy pregnancy. The woman should have an ideal weight because obesity increases the risk of complications like miscarriage and premature birth. Below, we will explain the most important tests required before ICSI for both partners.
Tests Required Before ICSI for the Wife
The wife needs to undergo several tests before ICSI. Some tests are designed to check the quality and quantity of eggs, and others to ensure the uterus is suitable enough to receive the embryo. There may also be some immune tests.
Blood Type Test
Before starting the ICSI process, the doctor needs to check the wife’s and husband’s blood types to prepare for blood type-related complications like Rh disease and ABO incompatibility.
Ovarian Reserve Test
Ovarian reserve can be defined as the number of existing egg cells that are potentially capable of being fertilized. It indicates the reproductive capacity of the ovaries. However, with advancing age, a female’s ability to conceive decreases, and the risk of miscarriage also increases.
Ovarian reserve can be assessed using serum tests or ultrasound imaging.
Anti-Müllerian Hormone (AMH) Test
The AMH test is one of the most important tests required before ICSI. It measures the level of Anti-Müllerian Hormone in the body, a hormone produced in the reproductive tissues of both females and males.
The AMH test helps determine ovarian reserve before ICSI, as there is a direct relationship between AMH levels in the body and fertility level. The higher the level, the higher the number of eggs. The AMH test is performed via a blood draw at any time during the month.
Low AMH test results (less than 1.3 ng/mL) indicate:
Approaching menopause.
Decreased egg quantity and quality, reducing the chances of pregnancy via ICSI.
Premature ovarian failure.
High AMH results may indicate increased pregnancy chances, but on the other hand, they may also indicate Polycystic Ovary Syndrome (PCOS).
Follicle-Stimulating Hormone (FSH) Test
FSH is known as Follicle-Stimulating Hormone and is one of the most important tests required before ICSI for the wife. This hormone plays an important role in ovarian growth and egg production, so it is important to test its level before ICSI to assess ovarian status and fertility rate.
The test to measure the hormone level is performed during days 2-5 of the menstrual cycle. FSH values higher than 10 IU/L indicate a low response to ovarian stimulation, meaning the woman has fewer eggs available for fertilization.
Luteinizing Hormone (LH) Test
LH helps regulate ovulation and the release of eggs from the ovaries, as its level rises in the middle of the menstrual cycle. The LH test helps determine if the woman suffers from some problems that prevent pregnancy.
If the LH level is high, it indicates an ovulation problem like Polycystic Ovary Syndrome, which should be treated before undergoing ICSI.
Thyroid Hormone Tests
Some thyroid disorders can lead to fertility problems and increase the risk of miscarriage and premature birth. Therefore, thyroid hormone levels should be checked before ICSI.
Prolactin Hormone Test
Prolactin is the hormone that contributes to breast milk production. High levels may prevent pregnancy. Prolactin level is measured through a blood test. Based on the prolactin level, your doctor decides which medication regimen suits your condition.
Uterine Examination
A uterine examination before ICSI is performed using three methods: hysteroscopy, hysterosalpingography (HSG), or saline infusion sonohysterography (SIS). Before ICSI, a mock transfer can be performed to determine uterine length and direction. This helps the doctor anticipate any problems related to embryo transfer, such as:
Uterine problems like polyps and adhesions.
Fibroids.
Blockage or inflammation of the fallopian tubes.
Weak endometrial lining.
Polycystic ovaries.
Ultrasound Examination of the Ovaries and Uterus
Ultrasound can be used to examine the ovaries and uterus, ensure their health, and confirm the absence of any problems that might hinder ICSI and affect its success, such as polyps or fibroids.
Fallopian Tube Patency Test
A fallopian tube patency test is a procedure used to check if the fallopian tubes are blocked or open. This procedure can also be used to check the shape of the uterine cavity and fallopian tube patency to determine the type of treatment a woman needs for successful pregnancy. This test is called an HSG (Hysterosalpingogram) and should be performed at a specialized imaging center.
Pap Smear
It is important to have a recent Pap smear test before undergoing ICSI.
Tests to Determine Miscarriage Risk
There are some tests that can help assess common causes of miscarriage through blood tests. Usually, a blood test is suggested to check for lupus anticoagulant, anticardiolipin antibodies, anti-beta-2 glycoprotein I antibodies, and TSH for this purpose. Their results can help the doctor know if you have an increased risk of miscarriage or other complications during pregnancy. In this case, your doctor can help you start treatment to reduce these risks.
Tests Required Before ICSI for the Husband
There are several tests for the husband before ICSI. While some may be optional tests to increase the chance of pregnancy with a healthy embryo, semen analysis is often required to determine sperm shape, count, and motility.
Semen Analysis
Semen analysis is the microscopic examination of sperm shape, count, and motility. It is performed on fresh semen in the laboratory. Male infertility can be diagnosed using this test. A recent semen analysis is essential before ICSI to assess semen quality.
Based on the semen analysis results and in case of male infertility, your doctor may suggest undergoing treatment before ICSI to ensure its success.
If there is a problem with sperm production, a testicular biopsy (where a small piece of testicular tissue is removed) may be needed. Blood tests may be needed to re-evaluate hormone levels.
How Do I Prepare Myself for ICSI?
After confirming that pregnancy through ICSI might be a good option for you regardless of the cause of infertility, you need to undergo some tests to see if both partners are suitable for this procedure.
To increase your chances of success, you need to undergo multiple tests before starting ICSI. This is to ensure you have a good chance of pregnancy, your body is ready to start the procedure and capable of nurturing a healthy embryo, reduce the risk of transmitting diseases to the baby, and also help the doctor determine the necessary medications and protocols for preparation.
Tests Required Before ICSI for Both Partners
Screening for Infectious Diseases
To reduce the risk of complications caused by infectious diseases, both partners should undergo some blood tests to screen for infectious diseases like HIV, Hepatitis B and C, and Syphilis. All of these can pose a risk to the fetus and cause complications during pregnancy. If your test result is positive, additional tests, treatments, and counseling may be needed before you decide to start ICSI.
Chlamydia Test
This test is also performed for both partners. However, unlike screening for other diseases, chlamydia is tested through a urine test for the husband and a vaginal swab for the wife. A blood test can also help screen for chlamydia antibodies, letting the doctor know if you have had a chlamydia infection. Chlamydia infection can damage the fallopian tubes.
Screening for Genetic Diseases
You may also need to be screened for sickle cell anemia, thalassemia, or other genetic disorders if you have a family history or come from a population where a specific disease is prevalent, like sickle cell anemia.