Intracytoplasmic Sperm Injection:
Intracytoplasmic sperm injection (ICSI) involves the direct injection of sperm
into eggs obtained from in vitro fertilization (IVF).
How is ICSI performed?
There are basically five simple steps to ICSI which include the following:
1. The mature egg is held with a specialized pipette.
2. A very delicate, sharp, and hollow needle is used to immobilize and
pick up a single sperm.
3. The needle is then carefully inserted through the shell of the egg and
into the cytoplasm of the egg.
4. The sperm is injected into the cytoplasm, and the needle is carefully
5. The eggs are checked the following day for evidence of normal
Once the steps of ICSI are complete and fertilization is successful, the
embrto 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:
Congenital absence of vas
Scarring from prior infections
Non-obstructive azoospermia occurs when a defective testicle is not
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 achieving pregnancy without
ART procedures 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.