Informed Consent                      Send Link

Microinsemination is a procedure that can be used to increase the chance of fertilization for a couple undergoing in vitro fertilization and embryo transfer (IVF-ET) who may have a reduced chance of fertilization through standard egg insemination procedures. Clinical situations in which the techniques of assisted fertilization may be useful include cases of male infertility, immunological infertility, or when there has been failure of fertilization or low rate of fertilization in previous IVF treatment sessions. The method of microinsemination used at GRS is intracytoplasmic sperm injection, or ICSI.

Eggs and sperm are obtained by using standard methods during an in vitro fertilization treatment cycle. Sperm are then prepared in a manner to select and retain only the most active sperm in a small volume of culture medium. After exposing the mature eggs to an enzyme that removes the cumulus cells which surround the egg, each egg is placed under a microscope and held in place by gentle vacuum with a small glass tube called a micropipette. A single sperm is then drawn up into an extremely sharp, hollow glass needle along with a very small amount of the nutrient liquid medium. The needle is then passed through the zona pellucida (the gel-like substance surrounding each egg) and the cell membrane to inject the sperm into the center of the egg by using a special microscope assembly. Approximately 16-18 hours after ICSI, the eggs are examined under the microscope to assess for the presence of two distinct pronuclei, which indicates normal fertilization. Subsequent maintenance of embryos and the performance of the embryo transfer is the same as standard IVF.

There are many thousands of on-going pregnancies and babies born worldwide since the introduction of ICSI. Unforeseen technical problems may arise which preclude successful fertilization via microinsemination. The likelihood of success cannot be predicted.

Microinsemination may increase the chances of pregnancy in couples whose chance of successful fertilization through standard IVF techniques is reduced. While microinsemination may increase the chances of becoming pregnant, there are no assurances, either stated or implied, that microinsemination may result in pregnancy.

The chance of any woman giving birth to a child with congenital birth defects in the United States is 3-4%, no matter how pregnancy is achieved. Available data does not indicate any reason to expect that microinsemination will result in increased incidence of chromosomal abnormalities in human infants.

The alternatives to microinsemination include increasing the sperm numbers that surround the egg while it is incubating in the laboratory or, in cases of male factor infertility, the use of donor sperm. Increasing the sperm concentration may increase the chance of fertilization but may have an adverse effect on the laboratory environment of the egg.

I/We, the undersigned, have read the above information and recognize the described potential benefits and risks of in vitro fertilization by microinsemination and uterine transfer of resultant embryos. I/We voluntarily request, authorize, and direct the personnel of GRS to perform any and all procedures necessary for in vitro fertilization, microinsemination, and embryo transfer, as well as any such additional procedures that any of the staff may deem necessary. I/We acknowledge that I/we have previously executed the In Vitro Fertilization - Embryo Transfer Consent and that this Consent to Microinsemination is in addition to, and supplements, such other Consent. Further, I/we understand that the contents and terms of all Georgia Reproductive Specialists consent forms that I/we have signed apply to this Consent and are incorporated herein by reference.


Patient Date
Partner Date
Notary Public/Witness Date