What is Intracytoplasmic Sperm Injection (ICSI)

ICSI — which stands for Intracytoplasmic Sperm Injection — involves the direct injection of a single sperm into each egg under direct microscopic vision. The introduction of ICSI has made it possible to fertilize eggs with sperm derived from men with the severest degrees of male infertility and in the process, to achieve pregnancy rates as high, if not higher than those that can be achieved through conventional IVF in non-male-factor cases.

In traditional In Vitro Fertilization, an egg is placed in a Petri dish with several hundred thousand sperm, where it is fertilized (hopefully) by a motile, morphologically normal sperm cell. With ICSI, all that is needed is a single sperm of reasonable morphologic quality. Motility is no longer a major factor in fertilization, since the sperm is carried to the egg and injected directly into it.

In fact, even when there is an absence of sperm in the ejaculate such as occurs in cases of congenital absence of the Vas deferens (when a man is born without these major sperm collecting ducts), in cases where the vasa deferentia (ducts that carry the sperm from the testicles to the urethra for ejaculation) are obstructed (such as following vasectomy or trauma), in some cases of testicular failure, or where the man has impotency, ICSI can be performed with sperm obtained through Testicular Sperm Extraction (TESE), or aspiration (TESA). In such cases, the birth rate is usually no different than when IVF is performed for indications other than male infertility. The successful performance of ICSI requires a high level of technical expertise by the embryology lab. SIRM performs ICSI on virtually 100% of IVF cases in our onsite laboratory facilities.

As a general principle, if the male factor cannot be reversed in the man’s body by simple medical or surgical treatment, then IVF with ICSI represents the only rational approach. Results are so high, some couples even choose this treatment mode instead of other medical or surgical treatments – even in those who are good candidates for these other treatments. Intrauterine insemination is not an effective way of treating moderate to severe male infertility.

The introduction of ICSI has made it possible to fertilize eggs with sperm derived from men with the severest degrees of male infertility and in the process to achieve pregnancy rates as high, if not higher than that which can be achieved through conventional IVF performed in cases of non-male factor related infertility. The performance of ICSI in cases of “male factor infertility” has been shown to slightly increase the risk of certain embryo-chromosome deletions (leading to a slight increase in early miscarriages) as well as the potential for a resulting male offspring to have male infertility in later life. There is no evidence of any significant increase in the incidence of serious birth defects attributable to the ICSI procedure itself. More relevant is the fact that when ICSI is performed for indications other than male infertility there is NO reported increase in the risk of subsequent embryo chromosome deletions, miscarriages or in the incidence of subsequent male factor infertility in the offspring.

ICSI Treatment

ICSI involves the direct injection of a single sperm into each egg under direct microscopic vision. The successful performance of ICSI requires a high level of technical expertise. In centers of excellence, when ICSI is employed, the IVF birth rate is unaffected by the presence and severity of male infertility. In fact, even when there is an absence of sperm in the ejaculate such as occurs in cases of congenital absence of the vas deferens, when a man is born without these major sperm collecting ducts, in cases where the vasa differentia are obstructed (such as following vasectomy or trauma), and in some cases of testicular failure or where the man has impotency, ICSI can be performed with sperm obtained through Testicular Sperm Extraction (TESE), or aspiration (TESA). In such cases, the birth rate is usually no different than when IVF is performed for indications other than male infertility.

ICSI Success Rates

A study was performed in Sweden, in which 542 children conceived naturally were compared with 941 children conceived through IVF (440 by conventional IVF and 541 by ICSI) . The following parameters were assessed at birth and during the first 5 years of life: a) birth health and obstetrical complications, b) birth defects or malformations, c) family relationships, d) physical development, e) mental, psychological, and social development. No major differences in birth weight, growth, total IQ, motor development, behavior problems, or parental stress were found between the children conceived with infertility treatments and those conceived naturally.

Learn more about ICSI, and read about Dr.Sher’s blog post: ICSI: Should it be Restricted to Male Infertility or be a Routine Part of all IVF?