Intracytoplasmic Sperm Injection

What is ICSI?

ICSI is an acronym for intracytoplasmic sperm injection
A fancy way of saying “inject sperm into egg”
ICSI is a very effective method to fertilize eggs in the IVF lab after they have been aspirated from the female
Its main use is for significant male infertility cases

IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and pick up individual sperm in a specially designed ICSI needle.
The needle is carefully advanced through the outer shell of the egg and the egg membrane – and the sperm is injected into the inner part (cytoplasm) of the egg.
This usually results in normal fertilization in about 75-85% of eggs injected with sperm.
However, first the woman must be stimulated with medications and have an egg retrieval procedure so we can obtain several eggs for in vitro fertilization and ICSI.

Who should be treated with intracytoplasmic sperm injection?

There is no “standard of care” in this field of medicine regarding which cases should have the ICSI procedure and which should not.

Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes.

Our thinking about ICSI has changed over time, and we are now doing more ICSI (as a percentage of total cases) than we were 10-12 years ago. As we learn more about methods to help couples conceive, our thinking will continue to evolve.

Common reasons used for performing ICSI
Severe male factor infertility that do not want donor sperm insemination.

Couples with infertility with:
Sperm concentrations of less than 15-20 million per milliliter
Low sperm motility – less than 35%
Very poor sperm morphology (subjective – specific cutoff value is debatable)

Having previous IVF with no fertilization – or a low rate of fertilization (low percentage of mature eggs that were normally fertilized).

Sometimes it is used for couples that have a low yield of eggs at egg retrieval. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (mixing eggs and sperm together).

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