ICSI (Intracytoplasmic Sperm Injection)

ICSI (intracytoplasmic sperm injection) 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.

What is ICSI?

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.

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.

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

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.