As a trainee and a junior trying to learn embryology in the early stages of my career, I was always in awe of that dazzling ICSI micromanipulator. More than the mechanics of the instrument itself, the overwhelming images of human oocytes being injected by Sperm got rooted in my psyche. In due process, the quest to grow in embryology became synonymous with that image. And I am certainly not alone! Trainees strive for not learning the whole process of ICSI but gatecrash to that final step of oocyte injection which is glamorous and creates euphoria of attaining growth.
In the midst of this process, a much more important part of the ICSI procedure gets overlooked. Sperm Immobilization is looked with disdain when on the contrary, it is more critical for oocytes to eventually fertilize.
As a student of embryology and ICSI, I would always vouch for learning sperm Immobilization and catching impeccably for a multitude of reasons. And before I dwell upon the same, I would like to highlight that the process of learning sperm immobilization can be made easy by embarking for courses in Embryology Academy for Research and Training which is affiliated to Shivani Scientific Industries Pvt. Ltd. The institute offers a comprehensive ‘Certificate Course in ART’ which is a 21-day training pertaining to all procedures in embryology. However, a prospective embryologist can utilize the hands-on aspect of the course to hone their sperm catching skills. A three-week continuous rigorous self-training on the same is the best highlight of the course work which can be primarily focused.
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Sperm immobilization is the centerpiece of a good ICSI and I would subdivide it into four smaller steps for better understanding. They are namely, priming of the injecting needle, immobilizing the sperm or in other words trapping it in between the base of the dish and the injecting needle, giving the immobilized sperm another slash to render it immotile completely with a characteristic kink in the tail and finally aspirating the selected sperm. Sperm immobilization is more important for a host of reasons.
Firstly, ICSI was originally introduced to tackle poor sperm quality. The ability of an embryologist then to select the best sperm becomes the key and so his expertise comes into play here. Having worked with some of the worst possible semen samples and few senior embryologists, I have seen getting good fertilization in such cases is difficult and can be a standpoint in testing good ICSI skills. Handling poor sperm morphology in severe Oligoasthenoteratozoospermia cases becomes indispensable in ICSI.
Secondly, oocyte injection is more mechanical and moreover, there is no choice. We have to inject whatever is retrieved and we do not possess the power to select or deselect oocytes or choose the fate of their quality. This is different with sperm as we have all the prowess to choose what we think is the best sperm with respect to its parameters. We can separate a good sperm from a bad one and find the best one like a needle from the haystack. The onus is entirely upon an embryologist to decide which sperm will be injected and which will be not. This gives sperm immobilization a necessity to be mastered.
Thirdly, as I mentioned smaller steps inside a sperm catching process, systematic learning of the same is essential. I have seen embryologists breaking needles during priming and few being ignorant about slashing again to give that necessary kink. It is important as we cannot put even a slightly motile sperm inside an oocyte and the said kink in the tail acts as a necessary signal for oocyte activation. Just touching the sperm and rendering it as immotile for injection is a half baked process of sperm catching and so a thorough understanding is a key.
Fourthly, learning sperm immobilization correctly also implies that as you choose the sperm at the highest magnification, we are also supposed to change the filter in the condenser unit to get that necessary contrast. I have seen people working with no filter or bright field mode even as they go for a higher magnification for sperm immobilization. This may still give you fertilization but then can be compromising for severe male infertility cases. These intricacies are ignored as you do not take immobilization seriously.
Lastly, ICSI should be learned in a flow where machine introduction and alignment should be perfected first followed by sperm immobilization and lastly oocyte injection. Individuals after knowing the machine directly parachute themselves for oocyte injections. This spoils the timely stepwise nature of learning ICSI and disturbs the tempo leading to the biggest casualty in form of poor sperm immobilization skills. Sperm immobilization needs that timely intervention and learning.
Sperm selection also becomes even more profoundly crucial when it comes to surgically retrieved samples in case of TESA/PESA and needs more proficiency in dealing with them.
Sperm immobilization needs maximum time and attention. Practicing it, again and again, is grueling or boring and that takes away the seriousness from it. Nevertheless, spending more time on sperm immobilization may give better fertilization and results. It’s mandatory for those who are already doing it to enhance the technique if they feel the need to do so. First timers need to focus on it more rather than fantasizing with those oocyte injection images as most of us do.
Finally, putting the perspective of this article in a nutshell, finding the right sperm in a million bypassing natural selection should outweigh other mechanical steps!
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