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ICSI is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments (HFEA 2010).
ICSI only requires one sperm, which is injected directly into the egg. The fertilized egg (embryo) is then transferred to your uterus (womb) (HFEA 2009a).
Could ICSI help us?During ICSI the sperm doesn’t have to travel to the egg or penetrate the outer layers of the egg. This means that it can help couples where the man’s sperm:
- can’t get to the egg at all
- can get to the egg, but for some reason can’t fertilize it
ICSI is likely to be recommended if your partner has:
- A very low or zero sperm count.
- A high percentage of abnormally shaped sperm. This can result in poor motility, which means the sperm can’t swim well.
- Sperm that can’t be ejaculated but can be collected from the testicles or from the duct where sperm is stored (epididymis). This may be needed if your partner has had an irreversible vasectomy or injury.
- Problems with getting an erection and ejaculating, due to spinal cord injuries or diabetes, for example (HFEA 2009a).
If you have tried IVF you may move on to ICSI if not enough eggs could be retrieved, or if eggs retrieved for IVF were not successfully fertilized (HFEA 2009a).
Is ICSI the answer for all male fertility problems?ICSI isn’t the solution to every male fertility problem. If your partner has a low sperm count as a result of a genetic problem, this could be passed on to any sons you have together. Your doctor will usually recommended that your partner has a blood test before you start the ICSI cycle (NCCWCH 2004, HFEA 2009a).
You and your partner should be offered counseling before and after taking the test to help you through both the decision and the process.
How is ICSI carried out?As with standard IVF treatment, you will be given fertility drugs to stimulate your ovaries to develop several mature eggs for fertilization. When your eggs are ready for collection, you and your partner will undergo separate procedures.
Your partner may produce a sperm sample himself by ejaculating into a cup on the same day as your eggs are collected. If there is no sperm in his semen, doctors can extract sperm from him under local anesthetic. Your doctor will use a fine needle to take the sperm from your partner’s:
- epididymis, in a procedure known as percutaneous epididymal sperm aspiration (PESA), or
- testicle, in a procedure known as testicular sperm aspiraction (TESA)
If these techniques don’t remove enough sperm, your doctor will try another tactic. He’ll take a biopsy of testicular tissue, which sometimes has sperm attached. This is called testicular sperm extraction (TESE) or micro-TESE, if the surgery is carried out with a microscope.
TESE is sometimes carried out before the treatment cycle begins, and under local anesthetic. The retrieved sperm are frozen. Any discomfort felt by your partner should be mild and can be treated with painkillers.
After giving you a local anesthetic, the doctor will remove your eggs using a fine, hollow needle. An ultrasound helps the doctor to locate the eggs. The embryologist then isolates individual sperm in the lab and injects them into your individual eggs. Two days later the fertilized eggs become balls of cells called embryos.
The procedure then follows the same steps as in IVF. The doctor transplants one or two embryos into your uterus and through your cervix using a thin catheter.
If you are under 40 you can have between one and three embryos transferred. If you are 40 or over you will likely be offered a maximum of four embryos transferred if using your own eggs, or two if you’re using donor eggs. Extra embryos, if there are any, may be frozen in case this cycle isn’t successful.
Embryos may be transferred two to three days after fertilization, or five days after fertilization. Five days after fertilization the embryo will be at the blastocyst stage. If you’re just having one embryo transferred (called elective single embryo transfer, or eSET), having a blastocyst transfer can improve your chances of a successful, healthy, single baby (Blake et al 2007).
If all goes well, an embryo will attach to your uterus wall and continue to grow to become your baby. After about two weeks, you will be able to take a pregnancy test.
How long does ICSI treatment last?One cycle of ICSI takes between four weeks and six weeks to complete. You and your partner can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You’ll go back anywhere between two days and six days later for the embryo transfer procedure.
What are the success rates of ICSI?The success rates for ICSI are higher than if you use conventional IVF methods. A lot depends on your particular fertility problem and your age. The younger you are, the healthier your eggs usually are, and the higher your chances of success.
What are the advantages of ICSI?
- ICSI may give you and your partner a chance of conceiving your genetic child when other options are closed to you.
- If your partner is too anxious to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI (NCCWCH 2004:109).
- ICSI can also be used to help couples with unexplained infertility. Though experts haven’t found that ICSI makes pregnancy any more likely than standard IVF (Check et al 2011, NCCWCH 2004:120).
- ICSI doesn’t appear to affect how children conceived via the procedure develop mentally or physically (Alukal and Lamb 2008).
What are the disadvantages of ICSI?
- ICSI has been in use for a shorter time than IVF. So experts are still learning about its possible effects.
- The same risks associated with standard IVF procedure, such as multiple births and ectopic pregnancy, apply to ICSI.
- You may have a higher risk of congenital conditions such as cerebral palsy in your baby (Alukal and Lamb 2008, Fortunato and Tosti 2011). The risk rises from three per cent for naturally conceived children to about six per cent after IVF or ICSI (Sala et al 2011, Bonduelle et al 2005). One large study found a higher rate of abnormalities in ICSI babies when compared with IVF babies. But this risk is still low.
- During natural conception, only the hardiest sperm manage to travel great distances and break through the membrane of an egg to fertilize it. Weaker sperm don’t make it.
But because ICSI bypasses this natural selection process, there’s an increased risk of rare genetic problems carried by the sperm being passed on to the child. Some but not all genetic problems can be tested for before you have the treatment (Alukal and Lamb 2008, HFEA 2009c).
- ICSI is a more expensive procedure than IVF (Check et al 2011, NCCWCH 2004:120).
Rest assured that ultrasounds during early pregnancy will monitor your baby’s development. And if you have any worries, you will be able to talk to your doctor.
You can chat to others about ICSI in our community.
Last reviewed April 2013
ReferencesAlukal JP, Lamb DJ. 2008. Intracytoplasmic Sperm Injection (ICSI) – What are the risks? Urol Clin North Am. 35(2): 277-88. www.ncbi.nlm.nih.gov [Accessed January 2012]
Blake D, Farquhar C, Johnson N, et al. 2007. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database of Systematic Reviews. 4: CD002118. www.onlinelibrary.wiley.com [pdf file, accessed January 2012]
Bonduelle M, Wennerholm UB, Loft A, et al. 2005. A multi-centre cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception. Hum Reprod 20(2): 413-9
Check JH, Yuan W, Garberi-Levito MC, et al. 2011. Effect of method of oocyte fertilization on fertilization, pregnancy and implantation rates in women with unexplained infertility. Clin Exp Obstet Gynecol 38(3): 203-5
Fortunato A, Tosti E. 2011. The impact of in vitro fertilization on health of the children: an update. Eur J Obstet Gynecol Reprod Biol 154(2): 125-9
HFEA. 2009a. What is intra-cytoplasmic sperm injection and how does it work? Human Fertilization and Embyrology Authority. [Accessed January 2012]
HFEA. 2009b. Intra-cytoplasmic sperm injection (ICSI): chance of success. Human Fertilization and Embyrology Authority. www.hfea.gov.uk [Accessed January 2012]
HFEA. 2009c. Intra-cytoplasmic sperm injection (ICSI): the risks. Human Fertilization and Embyrology Authority. www.hfea.gov.uk [Accessed January 2012]
HFEA. 2010. Latest UK IVF figures - 2008. Human Fertilization and Embyrology Authority. www.hfea.gov.uk [Accessed January 2012]
NCCWCH. 2004. Fertility: assessment and treatment for people with fertility problems - full guideline. National Collaborating Centre for Women's and Children's Health. London: RCOG Press. www.rcog.org.uk [pdf file, accessed January 2012]
Sala P, Ferrero S, Buffi D, et al. 2011. Congenital defects in assisted reproductive technology pregnancies. Minerva Ginecol 63(3): 227-35