Posted on 02/15/2019 in Fertility Treatment Options

Cost of IVF with ICSI

Cost of IVF with ICSI

The most successful IVF cycles are synchronized with ICSI 

In vitro fertilization cycles are the smartest and the most powerful options ever in infertility dimension. There is no term for “ideal IVF” or “ideal IVF cycle.” Every In-vitro cycle is designed exclusively for every case. But nearly every In-Vitro Bundle has one similar option called “ICSI.”

What is ICSI?

ICSI (or intracytoplasmic sperm injection) is the cutting–edge fertilization technique that is used in the IVF cycles. It is an ideal and the most powerful fertilization technique ever in IVF. Intracytoplasmic sperm injection is possible to perform only in the IVF cycle.

Taken to the extreme, ICSI makes it possible to perform the cutting–edge penetration of the oocyte’s cytoplasm (“zona pellucida”) by the ICSI pipettes loaded with sperm, and gentle progression through the oolemma with minimal risk of oocyte tearing during the fertilization (embryo creation).

Intracytoplasmic sperm injection involves the most secure quality authentication for every single spermatozoon, the most accurate ICSI pipettes with parallel walls allowing for ideal control of loaded sperms and unique tapers that widens later to ensure less damage to the oocyte during the sperm microinjection procedure, and a breakthrough dual–oocyte–holding system with oocyte immobilization control and penetration depth control during ICSI. Everything is taken to the extreme quality.

ICSI cost

ICSI cost is not as high as you may think. But ICSI is possible only in the IVF cycle; therefore, the IVF package usually includes ICSI cost.

But if you are interested in approximate ICSI costs, here we may note that approximately, ICSI costs vary from 500EUR to 2000EUR.

IVF with ICSI cost 

IVF with ICSI cost varies from IVF bundle to bundle and from country to country. And even in one country, the IVF with ICSI costs vary from clinic to clinic. Wondering why? Every clinic has its preference in devices, microtools, medications, treatment protocols, fertility evaluation tests, and many other things that impact on the IVF cost.

The second thing that has a great impact on IVF cycle cost is the treatment protocol that should be designed inclusively in every case. As every couple’s case is unique, they discuss with the medical team what protocols will be the most effective in this case.

The Medical Team designs the flexible IVF protocols with consultations, pre–treatment tests, and IVF bundle with the flexible additional options that may be included or excluded. Additionally, there are “Gold IVF Packages” that include everything starting with consultations, tests and medications and finishing with unlimited attempts. Surely, these IVF Packages cost is higher.

There are nearly 12 variations of IVF cycles that are possible to design in Europe. Every IVF Package has its own cost. But the final IVF invoice cost may be different because it is impossible to predict all the techniques that would be necessary for the IVF cycle.

IVF with ICSI cost in Europe and the other countries is given below:

We have compared IVF with ICSI cost in Azerbaijan, Georgia, Cyprus, Dominican Republic, India, Israel, Italy, Japan, Latvia, Mexico, Poland, Portugal, Slovakia, South Korea and Spain.

In Vitro Fertilization (IVF) with ICSI                                                       2900 EUR – 5000 EUR

IVF + ICSI with Sperm Donation                                                              4000 EUR – 5000 EUR

IVF + ICSI with Egg Donation                                                                    5000 EUR – 12,000 EUR

IVF + ICSI with Tandem Cycle (own oocytes and donated oocytes)   5500 EUR – 12,000 EUR

IVF + ICSI with Oocyte + Sperm Donation (Embryo Donation)            5750 EUR – 10,000 EUR

IVF + ICSI with Tandem Cycle + Sperm Donation                                  6000 EUR – 14,000 EUR

IVF + ICSI with Pre–implantation Genetic Diagnosis (PGD)                  3500 EUR – 7,000 EUR

IVF + ICSI with Sperm Donation + PGD                                                   6000 EUR – 8,000 EUR

IVF + ICSI with Egg Donation + PGD                                                        6000 EUR – 12,000 EUR

IVF + ICSI with Tandem Cycle + PGD                                                       6500 EUR – 16,000 EUR

IVF + ICSI with Tandem Cycle + Sperm Donation + PGD                     5500 EUR – 10,000 EUR

IVF + ICSI with Embryo Donation + PGD                                                7000 EUR – 16,000 EUR

Please check all prices in our IVF Cost Comparison 

IVF babies? What is left on the “backstage”? 

Every in vitro fertilization protocol is authentic and designed exclusively for the unique issue. Every IVF cycle is fueled by the extensive knowledge and powdered by an experienced medical team. Embryologists, OB/GYN, reproductive endocrinologists, reproductive surgeons, urologists, and other medical staff are involved in the IVF cycle design and implementation.

The most durable stage of IVF is fertility testing and ovarian stimulation. It may take a LONG timeline. IVF sometimes is really long. The most durable stage ever in the IVF cycle. 

Any IVF cycle starts with fertility testing and ovarian stimulation protocol. Fertility medications, injectable hormones, vitamins, and minerals are taken to stimulate the ovaries to produce more oocytes that soon will be retrieved surgically. Blood tests and internal ultrasounds are done to manage the efficiency of the ovarian stimulation protocol.

 Ultrasounds, Blood tests and Needles 

They will collect your blood sample nearly every time you have an appointment with your Reproductive Endocrinologist. There will be more blood work than you ever had in your life! Not to worry though, they will just be measuring your hormonal levels, investigating your blood type, and your Rh factor blood test, looking for infectious diseases since they are going to be messing with your DNA in the laboratory. And what if you're a Needlephobic? Being a Needlephobic person is not a problem when carrying out your treatment, the good news is that unlike your "regular" needles these are much smaller in size, more like diabetes needles, so there's no need to be scared! plus all of it will be worth it once you have your baby in your arms.

Ovarian stimulation and shots!

Injectable hormones to stimulate ovaries will be injected in your tummy by you. You will do a medical training session with the certified nurse because you will make yourself tummy shots. And in the end – the Trigger Shot! 

(1) Oocyte retrieval & oocyte collection

After that, the oocytes will be retrieved surgically via follicle aspiration procedure (oocyte collection). Oocytes are retrieved before ovulation. Retrieved oocytes will be immediately transferred to the laboratory where the story of your embryo–baby soon will begin.

Sperm collection or surgical sperm retrieval (PESA (Percutaneous Epididymal Sperm Aspiration), MESA (Micro Epididymal Sperm Aspiration), TESE (Testicular Sperm Extraction) or Micro–TESE (Microsurgical Testicular Sperm Extraction) will be synchronized in the timeline with the oocyte retrieval.

“Embryo generation event” has several stages that are performed in the laboratory and are synchronized in the timeframe

The oocyte has the largest not intuitive “interface” ever. Oocyte “Sunburst Interface” of the surrounding follicular cells makes it exclusive, the most powerful and secured one.

After the oocyte collection, there is one more step before sperm microinjection – oocyte preparation (or “denudation.”)

Every oocyte has the most “secure high–tech authentication system” ever. Believe it or not, every time millions of sperms are trying to reach it, most of them will die. And only one single spermatozoon will be lucky enough to fertilize the oocyte, and the brand–new assembly of life will begin.

But how does the oocytec choose the spermatozoon? Should it be with extra “skilled”? a “fast–mover”? Should it be “handsome”? Or should it be  the “healthiest”?  The answer to every concept is “Yes.”

Fast–mover, with ideal genetic content and “handsome” (with perfect morphology), desiring to achieve the oocyte in the shortest time, with cutting–edge penetration skills will be awarded the title “the One.” The others, even reached the oocyte, even trying to perform the penetration will die “in the middle” of the process. But why?

Every oocyte is “hidden inside” the lawyers of many cells. Together they “design” the most secure envelope ever.

Every retrieved oocyte has several layers of somatic cells “granulosa” or “corona radiata” that have the “most secure authentication” with every spermatozoon that tries to perform the penetration inside and fertilize the oocyte. Beneath the “corona radiate” lays the “zona pellucida” which is involved in binding the spermatozoon, and through which the single spermatozoon must also penetrate prior to fertilization.

(2) Oocyte preparation for ICSI

Before intracytoplasmic sperm injection, the oocytes should “undergo” denudation. Oocyte denudation is the micromanipulation removal of the somatic cell layers that surround (“envelope”) the oocytes.

Most of the oocyte envelopes are removed and the oocyte is remaining “nearly naked.” Only the zona pellucida is left. Being “nearly naked” in one or two transparent envelopes left, oocyte’s cutting–edge secure anti–penetration system fails and allows the ICSI to be performed easily. Excluding the risks to disrupt its fertilization potential.

Being inside the follicle, the oocyte is “enveloped” in two different cell layers, called granulosa cells and thecal cells that provide oocyte nutrition and maturation. Granulosa cells and ovarian thecal cells provide essential metabolites, hormones, and growth factors that are vital for the oocyte.

If these “envelopes” are so essential for the oocyte, will the oocyte be damaged after denudation? Nope. The oocyte has smart self–management system, something like “the most powerful chip ever.” Therefore, it is capable of modulating the follicular environment to guarantee correct preantral, antral, and preovulatory development.

What is denudation? How do they perform denudation? 

The denuding is done under stereomicroscopic control inside a petri dish. The oocytes are repeatedly inhaled into a glass denuding micropipette until all outer cell layers have been sheared off. After nearly all the “envelopes” are removed (except the zona pellucida), oocyte quality is investigated via stereomicroscope.

Oocyte quality for ICSI. How do they evaluate oocyte quality?

After that, the oocyte is thoroughly examined. Oocyte quality is based mainly on its morphology. But sometimes, the morphological evaluation is controversial. In these cases, the evaluation of the oocyte quality is also based on cellular and molecular predictors. If there are no morphological abnormalities, the oocyte is ready for ICSI procedure.

(3) Sperm collection 

Sperm collection is the simplest procedure in the IVF cycle. The sperm sample should be collected in the specimen container. Usually, the sperm sample is collected in a private room near the laboratory to limit the exposure of the semen to fluctuations in temperature and to control the time between collection and analysis.

Some fertility clinics even have medical sperm collector machines or automatic semen collection devices.

After that, the specimen container is labelled with the man’s name, identification number, the date and time of collection and placed on the bench or in an incubator (37 °C) while the semen liquefies.

(4) Surgical sperm retrieval PESA (Percutaneous Epididymal Sperm Aspiration); MESA (Micro Epididymal Sperm Aspiration); TESE (Testicular Sperm Extraction) or Micro–TESE (Microsurgical Testicular Sperm Extraction)

Sometimes there is no sperm present in the man’s ejaculation. The absence of sperm in the ejaculation is called “azoospermia.” Azoospermia can be obstructive and non-obstructive.

The most probable causes of obstructive azoospermia are vasectomy, trauma, congenital absence of Vas Deferens, trauma during abdominal or inguino–scrotal surgery, or Epididymal scarring from previous infections. Non-obstructive azoospermia is the medical condition when there is no sperm in the semen its because the body produces abnormal sperm.

In these cases, sperm can be retrieved surgically from the testicle or epididymis.

PESA or Percutaneous Epididymal Sperm Aspiration is performed in the following way: urologist takes a small needle that passes directly into the head of the epididymis through the scrotal skin and semen fluid is aspirated. After that, the embryologist retrieves the sperms from the semen fluid, investigates them, and prepares them for ICSI.

Invasive sperm retrieval techniques

Microsurgical Epididymal Sperm Aspiration (MESA) is done in case of obstructive azoospermia. It involves surgical dissection of the epididymis under the operating microscope and incision of a single tubule. This technique has one disadvantage of collecting the blood cells with the semen fluid. And the blood cells may affect sperm fertilization.

Testicular sperm extraction (TESE) is a surgical biopsy of the testis and is an invasive sperm retrieval technique. It also needs general anesthesia. Sometimes, during TESE the urological surgeons make too large incisions in the scrotum and the testicle that seems longer recovering after the surgery.

TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then transferred in the embryology laboratory where the sperm cells extracted and used for ICSI.

Micro-TESE – minimally invasive technique for sperm retrieval in cases of non-obstructive azoospermia

Micro-TESE is recommended if there is an adequate level of testosterone (male hormone) in sperm test results. It is Many experts strongly recommend saying “NO” if you are proposed having fine needle aspiration or biopsy before micro–TESE. Despite micro–TESE is one of the minimally invasive sperm retrieval techniques, it is done under general anesthesia. And sometimes more than one micro–TESE procedure is necessary for IVF.

(5) Sperm preparation (semen preparation) 

Sperm cells are called “spermatozoa,” and the single sperm cell is called “spermatozoon.”

The spermatozoon is like a super powerful “chip” cell with localized membrane domains that have specific functions. The domains have heterogeneous fluidity, shape, diffusion coefficients and composition of phospholipids, glycolipids, and steroids.

There are five specialized regions: the acrosomal, equatorial, postacrosomal, midpiece and tail region.

The spermatozoon membrane is a dynamic system undergoing many changes, often domain specific, as the spermatozoon passes through the reproductive tract. These maturational changes are thought to be essential for eventual fertilization of the oocyte.

Extensive understanding of sperm morphology and physiology, revealing its morphological and physiological peculiarities, and designing the cutting–edge sperm preparation techniques reframed the definition of a good sperm preparation technique.

A good sperm preparation technique results in a sample with high viability and motility and also takes into account other parameters such as the capacitation and apoptotic state which could compromise the ability to fertilize an oocyte.

Sperm preparation procedures [pre–wash procedures] include basic semen testing, standard semen fluid tests and specialized semen tests for diagnostic purposes.

Sperm washing, also known as sperm processing or sperm preparation, is the technique that separates sperm from the seminal fluid for use in infertility treatments. The simple sperm washing technique is usually used when the semen sample has optimal parameters for further fertilization.

But this technique is not the “golden standard” for all cases. There are also migration–based techniques (swim-up, migration-sedimentation, swim-down), density gradient centrifugation, double density gradient centrifugation, magnetic activated cell sorting, glass wool filtration etc. In every case, the sperm preparation technique may have the exclusively designed strategy of its performance.

Direct swim-up sperm preparation technique is used for sperm samples with good or average motility.

Migration-sedimentation sperm preparation technique is used for semen samples with low motility.

Swim-Down sperm preparation technique relies on the natural movement of sperm cells.

Density gradient centrifugation separates sperm cells based on their density. At the end of centrifugation, each spermatozoon is located at the gradient level that matches its density. Morphologically normal and abnormal spermatozoa have different densities. The top–quality sperms are retrieved from semen liquid and are used for ICSI.

Magnetic activated cell sorting (MACS) separates apoptotic (dead, nearly dead) spermatozoa from non–apoptotic (alive) sperms.

Glass wool filtration separates motile sperm cells from other contents of semen by filtration through densely packed glass wool fibers.

There is no ideal sperm preparation technique with 100% accuracy for every case. But in every case, it is possible to find the ideal sperm preparation technique.

It should be gentle and one that recovers highly functional sperms. Serial centrifugation of the semen is known to induce sperm dysfunction mediated through production of reactive oxygen species by spermatozoa and leucocytes. That is why more gentle sperm selection techniques such as double density gradient centrifugation and swim–up procedures have evolved and are widely implemented in practice.

Framing ICSI procedure 

Synchronized with IVF protocol, the first steps of ICSI involve the surgical oocyte retrieval via follicle aspiration and the oocytes’ denudation (the removal of the cumulus and the corona radiata cells through micromanipulation techniques). In parallel, sperm is prepared using sperm-preparation techniques such as swim-up or density gradients or the other technique. After that, a single spermatozoon is selected and injected into an oocyte through a thin glass injection micropipette – ICSI injection pipette. If fertilization occurs, the embryo is transferred into the uterus on day 2, day 3 or day to 5 after ICSI procedure.

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