ICSI (Intracytoplasmic Sperm Injection)

ICSI facts

  • Intracytoplasmic sperm injection (ICSI) is an infertility treatment done in conjunction with in vitro fertilization (IVF) that injects a healthy sperm into the cytoplasm of the female egg, where fertilization occurs.

  • Intracytoplasmic sperm injection is typically used to address male infertility due to poor quality, quantity and/or movement of sperm that prevents it from penetrating the outer layer of an egg (called the zona pellucida).

  • ICSI can also be useful if the female eggs’ zona pellucida is abnormally thick.

  • An IVF specialist also sometimes performs ICSI when a previous IVF cycle or intrauterine insemination (IUI) has failed.

  • Sperm for the ICSI procedure is usually obtained via masturbation or needle aspiration.

  • ICSI fertilizes 50% to 80% of eggs.

  • Although rare, complications can occur during or after the process including damage to the female partner’s eggs.

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What is intracytoplasmic sperm injection?

Intracytoplasmic sperm injection is a procedure used during IVF in which a healthy sperm is injected, via the use of a tiny needle called a micropipette, directly into the cytoplasm (center) of a healthy egg.

If fertilization takes place, the egg (oocyte) becomes an embryo that grows in the IVF laboratory for one to five days before it is transferred to a women’s uterus for pregnancy.

How does ICSI help male infertility?

In normal conception, the sperm travel to the woman’s fallopian tube and there fertilizes the egg by first attaching to the outer layer of the egg. Then it must push through the outer layer and move into the center of the egg, which is where fertilization happens.

Male infertility is often caused by issues that make it difficult or impossible for the sperm to either reach the fallopian tube (sperm’s ability to move) and/or fertilize the egg (sperm quality). ICSI overcomes many male infertility issues by identifying healthy sperm and injecting the sperm directly into the egg.

What is the infertility treatment success rate of ICSI?

ICSI has revolutionized treatment for couples who have severe male infertility because it places a sperm into the cytoplasm, and doesn’t depend on the sperm doing that on its own. ICSI successfully achieves fertilization in 50%-80% of eggs, according to the American Society for Reproductive Medicine (ASRM).

Prior to the development and advancement of ICSI, it was not unusual for a couple with severe male factor infertility to be unsuccessful with conventional IVF. Now couples with severe male factor infertility often have equivalent pregnancy rates to couples without male infertility issues.

ICSI success with the Dallas IVF lab

The chance of having a successful outcome with an ICSI & IVF cycle depends on the quality of the eggs and sperm, as well as the skill of the embryology staff performing the ICSI. Our senior embryology staff possess a combined experience of having performed ICSI on over 40,000 eggs.

Dallas IVF lab facilities are among the most modern in the world and use the cleanest ‘clean rooms’ that have been certified by Alpha Environmental, an internationally recognized air filtration company. This credentialing, granted to only a few labs in the country, certifies that our air quality is extremely pure, which is an important aspect of the lab environment that nurtures eggs, sperm and embryos.

How is ICSI different from IVF and IUI?

The key difference between ICSI and standard IVF is how sperm fertilize an egg. In a standard IVF procedure the egg is placed in a petri dish with about 50,000 sperm so fertilization can occur.

Alternately, ICSI injects one sperm into one egg. Using a high-powered microscope, the embryologist identifies a healthy-appearing sperm swimming in the sample, suctions it into a micropipette needle, and injects the sperm into the center of the egg. Once fertilization occurs and an embryo develops, the IVF process continues as normal, and the embryo is placed in the woman’s uterus so a pregnancy can develop.

ICSI is only done in conjunction with an IVF cycle. However, some people confuse ICSI with intrauterine insemination (IUI), another common male infertility treatment. IUI is a form of artificial insemination in which healthy sperm is inserted directly into a woman’s uterus, during the most fertile period of her menstrual cycle. This shortens the sperm’s journey from the vagina and cervix through the uterus to the fallopian tube, increasing the chance of fertilization.

Learn more about IVF | Learn more about IUI

Is ICSI right for me?

This procedure can help many couples with infertility, including the following.
  • Men who do not produce a sufficient quantity of sperm to be used in IVF or IUI.
  • Men with a very poor semen analysis, which may include poor motility (sperm movement), poor morphology (shape of the sperm) or other conditions preventing sperm from penetrating the egg.
  • Couples who have had a failed previous IVF cycle or IUI regardless of sperm quality.
  • Couples with a diagnosis of unexplained infertility.
  • Women whose ovulated eggs have an abnormally thick outer layer (zona pellucida) preventing sperm from being able to penetrate it for fertilization.
  • A man who has a blockage in the reproductive tract that is preventing sperm from releasing properly during intercourse.
  • Men who have nonobstructive azoospermia, which is a complete absence of sperm in the ejaculate due to a defective testicle. Some men in this category have had certain types of chemotherapy that may have compromised sperm production.
  • Men with congenital bilateral absence of the vas deferens (CBAVD). These men produce sperm, but are born without a vas deferens, part of the outflow tract.
  • Men who have had vasectomies. If a man has had a vasectomy and does not wish to have a reversal, a testicular sperm aspiration can be done to obtain sperm.
  • When frozen eggs are being used in IVF, we may recommend ICSI.

How is sperm obtained for ICSI?

Sperm in semen is primarily collected through normal ejaculation via masturbation. The sample can be collected at home or in our lab.

The live sperm is separated from the dead sperm and washed before being injected into the egg. The sperm can be retrieved on the day of ICSI or it can be retrieved beforehand and frozen.

Needle aspiration can be used in instances where the male partner is unable to provide a sperm sample via ejaculation. Sperm is extracted by a tiny needle inserted into the testicle where sperm is produced or into the epididymis through which it passes.

For men who produce sperm but have a blockage, we will most often perform the simpler testicular sperm aspiration (TESA). For men who have sperm production problems and other issues, we may need to perform a more involved procedure. Options include percutaneous sperm aspiration (PESA), testicular sperm extraction (TESE), microepididymal sperm aspiration (MESA), and microdissection TESE (microTESE).

These procedures are performed under either local or general anesthesia. Depending on the situation, they can be performed in our clinical offices or in our surgery center.

Risks & side effects of intracytoplasmic sperm injection

The procedure itself doesn’t add any risks to the man or the woman, as their sperm and eggs have already been collected through the typical IVF process.

ICSI can sometimes cause damage to the female partner’s eggs. The egg also might not grow into an embryo even after the procedure, or the embryo could stop growing before it’s ready for transfer to the uterus.

The effect on a child born after an ICSI procedure is a concern, though such issues are rare. Conditions like Angelman syndrome, Beckwith-Wiedemann syndrome, hyspodias and chromosome abnormalities have been associated with the use of ICSI. But ASRM reports their occurrence is far less than 1% of babies conceived with his procedure.

During natural pregnancy there is a 1.5% to 3% chance that a baby will have a birth defect. The chance of birth defects associated with intracytoplasmic sperm injection are comparable to IVF, but slightly higher than natural conception. Moreover, ASRM says this slightly higher risk of birth defects may be due to the cause of male infertility and not the treatments or procedures used to remedy the infertility.

A Dallas IVF fertility specialist can provide detailed information on the risks of an ICSI procedure and all fertility treatments in general.