Institute for Human Reproduction
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IHR Blog

IHR Blog

Intracytoplasmic Sperm Injection (ICSI)

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Used with IVF and eggs that are of good quality, ICSI is a successful treatment for men with impaired or very few sperm.

IVF ICSI revolutionized the treatment of male infertility, allowing fertilization to occur even if only a few sperm are available. First developed by reproductive medical specialists in Belgium, ICSI is a specialized form of microinsemination to help couples overcome male infertility problems such as: low sperm counts, poor motility (or movement) of the sperm, poor sperm quality, or sperm that lack the ability to penetrate an egg. ICSI has become so successful that most treatments previously used for male infertility have been abandoned in its favor. 

During routine IVF, eggs and sperm are combined and incubated together in order to achieve fertilization. ICSI is performed by the embryologist, who surgically inserts one sperm into each egg. This is done by perforating the membrane of the egg with a glass pipette containing a single sperm.

This procedure requires highly developed skills. Because only one sperm is needed per egg, even very small numbers of sperm can work. Even in men with no sperm in the ejaculate (azoospermia) ICSI can be used to achieve fertilization of an egg. In these cases, we can offer a procedure called testicular sperm extraction (TESE), where our urologist extracts a small piece of testicular tissue that may contain sperm cells that can be used for ICSI. In a very high percentage of cases, azoospermic males can achieve fatherhood. Another surgical procedure may also be performed called Percutaneous Epididymal Surgical Aspiration (PESA) 

Sometimes IVF with ICSI is done for "egg factor" cases - low ovarian reserve situations. This is when there is either a low number, or low "quality"of eggs (or both). In such cases, ICSI fertilization and pregnancy success rates tend to be lower. This is because the main determinant of IVF success is the quality of the embryos. The quality of the eggs is a crucial factor determining quality and viability of embryos.