Intracytoplasmic sperm injection or its acronym ICSI (pronounced “icksy”) is a procedure used in assisted reproduction treatment in which a single sperm is injected directly into an egg. ICSI requires a woman to undergo an IVF cycle so that eggs can be obtained for insemination.

When is ICSI used?

ICSI was originally used to overcome male infertility problems, such as low sperm count (oligospermia), poor motility or movement (asthenospermia), and in cases where sperm morphology (sperm shape or what they look like) is abnormal (teratospermia). ICSI is commonly used in cases where sperm are harvested from the male reproductive tract (epididymis or testis) as in cases of previous vascectomy, other obstructions, or because of problems with sperm production requiring intervention by a urologist to obtain sperm either by percutaneous epididymal sperm aspiration (PESA) or testicular epididymal sperm aspiration (TESA). ICSI is also performed in cases where prior fertilization attempts using standard insemination (10,000 sperm added to each egg) failed to fertilize the eggs, and in cases where there may be a low number of eggs obtained or if eggs are thought to be of poor quality. Most recently, ICSI has been used in many IVF centers to simply maximize fertilization; many barriers to fertilization can be overcome with this innovative but labor intensive procedure.

How is it done?

ICSI is performed under a microscope using micromanipulation devices. A holding pipette stabilizes the mature egg with gentile suction using a specially designed aspiration device. Another tool holds a very fine glass micropipette containing a sperm that had been previously picked up into the needle. The micropipette is inserted into the center of the egg so the sperm can be gently injected into the egg. The needle is then removed. Following ICSI, the egg with the injected sperm is placed into cell culture and checked the following day for signs of fertilization.

What is its success rate?

Early studies suggested that birth defects were increased with the use of IVF in general and ICSI specifically. Other studies have disputed these claims. A position paper published by the Practice Committee of the American Society of Reproductive Medicine has stated that it considers ICSI safe and effective therapy for male factor infertility, but may carry and increased risk for the transmission of selected genetic abnormalities to offspring, either through the procedure itself or through the increased inherent risk of such abnormalities in parents undergoing the procedure (Fertil Steril 90:S187;2008).

Both success rates and costs vary greatly between different IVF centers. The fertilization rate within the IVF Laboratory at The Fertility Centers of New England is exceptional (over 75%), and our costs for this procedure are the most competitive in the region.

ICSI may not be for everyone, but for those who otherwise could not be parents, ICSI offers them the potential to achieve their dream of having a successful pregnancy.

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