Intracytoplasmic Sperm Injection (ICSI)

What is ICSI?

Intracytoplasmic sperm injection (ICSI) is a laboratory procedure developed to help infertile couples undergoing in vitro fertilization (IVF) due to male factor infertility. In ICSI, a lab specialist uses a tiny needle under a microscope to inject a single sperm cell directly into the cytoplasm of a mature egg (oocyte). The process increases the likelihood of fertilization when there are abnormalities in the number, quality, or function of the sperm.

If preliminary semen analysis indicates that ICSI is a necessary and appropriate treatment, the couple will prepare for IVF. Instead of mixing the eggs retrieved from the woman with the man’s sperm in a glass dish (as in standard IVF, without ICSI), a single sperm cell is injected via a special glass needle called a pipette into an egg cell. At that point, about two-thirds of these sperm-injected eggs will fertilize and start developing toward embryo stage.

Embryo transfer usually occurs five days after oocyte retrieval. Good quality embryos that are not transferred at that time can be cryopreserved, or frozen, for later attempts at pregnancy.

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Who needs ICSI?

ICSI is beneficial for couples with infertility due to severe male fertility issues such as:

  • poor sperm motility, or movement (less than 10 percent motile)
  • abnormal morphology, or shape
  • oligospermia (very low sperm count)
  • azoospermia (zero sperm count) due to either vasectomy or other obstructions, or because of problems with sperm production

In addition to male infertility, ICSI can be recommended for couples with a history of failed IVF attempts. When infertility results from poor semen quality, ICSI provides a successful work-around with IVF. ICSI is also frequently used when patients chose to do PGT (pre-implantation genetic testing) of their embryos.

What are the risks of ICSI?

ICSI has been used since the early 1990s, and preliminary studies on the children born as a result of ICSI do not suggest an increase in congenital abnormalities. However, children conceived through IVF with ICSI for reasons of severe male factor infertility may be more likely to inherit certain genetic conditions. Also, some egg cells (less than 1 percent) are irreparably damaged by the ICSI process and never become embryos.