Intracytoplasmic Sperm Injection (ICSI)
When fertilization is difficult, ICSI helps by carefully combining one sperm and one egg in the lab.
Purpose
ICSI is used to help fertilize eggs when sperm count, motility, or morphology is poor, making standard fertilization less likely. It is also recommended when previous IVF cycles had low or failed fertilization, even when eggs were retrieved successfully.
Instead of relying on sperm to penetrate the egg naturally, ICSI allows fertilization to happen through a precise lab technique, increasing the chance that an egg can fertilize and begin embryo development—particularly in male-factor infertility.
ICSI is commonly considered when:
Sperm count is low or movement is poor (low motility)- Sperm shape is significantly abnormal (morphology issues)
- Sperm is obtained through surgical methods (TESA/TESE)
- A prior IVF cycle showed low or no fertilization
Procedure
ICSI injects a selected sperm directly into an egg to improve fertilization. Embryos are monitored, one is transferred, and others may be frozen
Egg & Sperm Preparation
After egg retrieval (as part of IVF), mature eggs are identified. A sperm sample is processed to select the healthiest, most motile sperm.
Sperm Selection
An embryologist chooses a single sperm under a high-powered microscope—selecting the best available sperm for injection.
Microinjection (ICSI Step)
Using a fine micro-needle, the embryologist injects one sperm directly into the egg. This helps overcome sperm-related barriers to fertilization.
Embryo Development
Injected eggs are monitored for fertilization and then cultured for several days as embryos develop. A selected embryo is later transferred to the uterus, and additional embryos may be frozen if suitable.
Benefits and Evidence
Benefits
- Dramatically improves fertilization in cases of male-factor infertility where sperm cannot fertilize the egg effectively on its own
- Useful after prior IVF fertilization failure, when eggs were retrieved but fertilization did not occur as expected
- Can be paired with genetic testing (PGT) in suitable cases to support embryo assessment and selection
Evidence
ICSI is widely used worldwide and is recognized in clinical practice guidelines (including WHO and ASRM) as an effective and safe technique for addressing male infertility, especially when there is clear sperm-related difficulty with fertilization.
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