Intracytoplasmic sperm injection (ICSI) can be used as part of an in vitro fertilisation (IVF) treatment to help you and your spouse to conceive a child.
ICSI is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments.
ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb).
How Is ICSI Performed?
There are basically five simple steps to ICSI which include the following:
- The mature egg is held with a specialized pipette.
- A very delicate, sharp, and hollow needle is used to immobilize and pick up a single sperm.
- The needle is then carefully inserted through the shell of the egg and into the cytoplasm of the egg.
- The sperm is injected into the cytoplasm, and the needle is carefully removed.
- The eggs are checked the following day for evidence of normal fertilization.
Once the steps of ICSI are complete and fertilization is successful, the embryo transfer procedure is used to physically place the embryo in the woman’s uterus.
Then it is a matter of watching for early pregnancy symptoms. The fertility specialist may use a blood test or ultrasound to determine if implantation and pregnancy has occurred.
Are There Specific Situations Where ICSI Might Be Recommended?
ICSI may be recommended when there is a reason to suspect that achieving fertilization may be difficult. ICSI is most often used with couples who are dealing with male infertility factors.
Male infertility factors can include any of the following: low sperm counts, poor motility or movement of the sperm, poor sperm quality, sperm that lack the ability to penetrate an egg, or azoospermia.
Azoospermia is a condition where there is no sperm in the male’s ejaculation. There are two types of azoospermia: obstructive and non-obstructive.
Obstructive azoospermia may be caused by any of the following:
- Previous vasectomy
- Congenital absence of vas
- Scarring from prior infections
- Non-obstructive azoospermia occurs when a defective testicle is not producing sperm. In the case of azoospermia, the probability of obtaining usable sperm is low, and the possibility of using donor sperm may be considered.
Is ICSI the answer for all male fertility problems?
ICSI isn’t the solution to every male fertility problem. If your spouse 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 recommend that your spouse has a blood test before you start the ICSI cycle.
You and your spouse may find should be offered counselling before and after taking the test, to help you through both the decision and the process. Your doctor could to refer you to a counsellor.
You can also read our Fertility A-Z page for more information.
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 fertilisation. When your eggs are ready for collection, you and your spouse will undergo separate procedures.
Your spouse 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 anaesthetic.
Your doctor will use a fine needle to take the sperm from your spouse’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 anaesthetic. The retrieved sperm are frozen. Any discomfort felt by your spousepartner should be mild and can be treated with painkillers.
After giving you a local anaesthetic, 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 fertilised 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 one or two embryos transferred. If you are 40 or over you can have a maximum of three 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 fertilisation, or five days after fertilisation. Five days after fertilisation 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.
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 Is Sperm Retrieved For Use In ICSI?
For men who have low sperm count or sperm with low mobility, the sperm may be collected through normal ejaculation.
If the man has had a vasectomy, the microsurgical vasectomy reversal is the most cost-effective option for restoring fertility.
Needle aspiration or microsurgical sperm retrieval are good alternatives when a competent microsurgical vasectomy reversal has failed, or when the man refuses surgery.
Needle aspiration allows physicians to easily and quickly obtain adequate numbers of sperm for the ICSI procedure. A tiny needle is used to extract sperm directly from the testis.
Needle aspiration is a simple procedure performed under sedation with minimal discomfort; however, there is the potential for pain and swelling afterwards.
The sperm obtained from testis is only appropriate for ICSI procedures when testicular sperm is not able to penetrate an egg by itself.
What Health Concerns Are There When Considering ICSI?
There have been studies indicating that developing babies from pregnancies achieved through artificial insemination, and particularly ICSI, may face an increased risk for some birth defects, such as imprinting defects.
Imprinting refers to the phenomenon in which certain genes function differently depending on whether they involve a particular chromosome passed on by the father or by the mother.
Reproductive researchers are concerned that manipulation of either gametes or zygotes may affect the imprinting process or the subsequent release.
Other researchers believe that the incidence of these birth defects occurring is similar to those in natural pregnancy, and therefore should not be a deterrent in using them.
The potential risks or complications from doing ICSI is something that you should discuss with your reproductive specialist at length about.
How long does ICSI treatment last?
One cycle of ICSI takes between four weeks and six weeks to complete. You and your spouse 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.
The percentage of cycles using ICSI which result in a live birth are:
- 35 per cent if you are under 35
- 29 per cent if you are between 35 and 37
- 21 per cent if you are between 38 and 39
- 14 per cent if you are aged between 40 and 42
- six per cent if you are between 43 and 44
- five per cent if you are over 44
What are the advantages of ICSI?
ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you.
If your spouse is too anxious to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI.
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.
ICSI doesn’t appear to affect how children conceived via the procedure develop mentally or physically.
What are the disadvantages of ICSI?
ICSI is a more expensive procedure than IVF.
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. The risk rises from three per cent for naturally conceived children to about six per cent after IVF or ICSI.
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 fertilise 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.
ICSI is a more expensive procedure than IVF.
Rest assured that ultrasound scans during early pregnancy will monitor your baby’s development. And if you have any worries, you will be able to talk to your doctor.