ICSI is an assisted fertilization procedure that has been introduced in 1992 to overcome this problem. It involves injection of a single sperm into an egg to help fertilization.

ICSI is a procedure by which an embryologist injects a single sperm into each egg using a micro-injection needle to assist fertilization, thus bypassing any potential problems the sperm will have in getting inside the egg.

What are the indications for ICSI?

It is performed for couples with certain indications:

  1. One or more of the sperm parameters is/are poor such as low sperm count, poor motility and/or poor morphology (abnormal shape).
  2. A previous IVF using conventional insemination had none or very few of the eggs fertilized.
  3. The sperm have to be collected surgically from the testicles.
  4. In pre-implantation genetic testing or PGT-A), ICSI will be used to prevent sperm sticking to the outside of the eggs during conventional IVF from interfering with the results.
  5. The eggs had been frozenand now are thawed for IVF treatment, the freezing process makes the outer coating of the eggs too tough for sperm to penetrate.
  6. The frozen-thawed spermdo not appear especially active, ICSI may be recommended.

How does a couple know if they need ICSI?

The husband has to undergo a semen analysis before IVF treatment, preferably in fertility centre so that the embryologists can assess the quality of the sperm in detail. Based on the results, the doctor will then decide which insemination method is more suitable. In some circumstances, the sperm quality may fluctuate widely and then the decision may have to be made on the day of egg collection based on the quality of the sperm on that day.

ICSI stands for Intracytoplasmic Sperm Injection which is an advanced form of IVF treatment. It is used in cases of male factor infertility where the male partner is suffering from the sperm related issues like low sperm count, poor sperm morphology or poor sperm quality.

How is ICSI procedure done is performed with the traditional IVF to create an embryo in the laboratory?ICSI is considered a safe and effective procedure and proves to be very helpful in male infertility treatment. The complete process is performed under the supervision of experts to ensure a flawless procedure. Ovarian simulation is done the same way as in normal IVF

  • The Eggs are retrieved from the intended mother
  • Sperm samples are retrieved from the intended Father
  • The mature egg is held with a specialized pipette.
  • A very delicate, sharp, and hollow injection needle is used to immobilize and pick up the single sperm.
  • The needle is then carefully inserted into the cytoplasm of the egg.
  • The needle is carefully removed after injecting the sperm into the egg.
  • The egg is kept in the lab and checked for the evidence of fertilization.
  • After the fertilization of the egg, embryos are cultured until day 5 and blastocyst is transferred into the uterus of the intended mother so that she can achieve conception.

Is it worth having ICSI even if there is no male factor infertility?

For couples who have no evidence of male factor infertility, the chances of getting pregnant are not related to whether they have ICSI or not. Once fertilization happens, the pregnancy rate for a couple using conventional insemination or ICSI is the same.

How does ICSI differ from IVF?

From a patient’s point of view ICSI is much the same as IVF, it is what happens in the laboratory that differs.

With IVF, the eggs are put in a petri dish together with several thousand prepared sperm and then left overnight for fertilisation to hopefully occur.


With ICSI, each mature egg is injected directly with a single sperm under a high-powered microscope. Whether IVF or ICSI is used, eggs are incubated in the laboratory overnight and examined the following day for signs of fertilisation.


Why does ICSI cost more than conventional IVF?

ICSI is a delicate and precise technique that requires the use of specialist micromanipulation equipment by highly skilled embryologists. It may cost slightly more than ivf treatment.

What are the success rates with ICSI treatment?Fertilisation rates are slightly higher with ICSI compared to IVF because it virtually guarantees that the sperm penetrates the egg. There is no significant difference in pregnancy rates between IVF and ICSI.

Are all the eggs collected used for ICSI?

ICSI can only be performed on mature eggs. Usually we expect about 75%-80% of eggs to be mature.

Does ICSI guarantee fertilisation?

ICSI maximises the chances of fertilisation where there is known to be an issue with sperm quality or quantity. Over 90% of couples having treatment with ICSI will achieve fertilisation of some of their eggs. Fertilisation cannot be absolutely guaranteed because numerous factors affect this, including egg number and quality.

How do the embryologists know which sperm to use?

The embryologists choose the sperm that are the most motile and which look the most normal shape. 

Can ICSI damage eggs?

The injection technique may sometimes damage individual eggs.  The overall damage rate is low (below 5% of eggs injected) but may be higher for women with poor quality eggs.

Are there differences in embryo quality or pregnancy rates between ICSI and non-ICSI embryos?

There appears to be no difference in the overall embryo quality achieved with ICSI embryos when compared to non-ICSI embryos. Similarly, no difference in pregnancy rates has been shown between ICSI embryos and non-ICSI embryos. Although unproven, there is a belief among many infertility specialists that ICSI may increase embryo yield from a given number of eggs recovered, which has contributed to the increase in ICSI procedures.

How successful is ICSI?

Through the ICSI procedure, many couples with difficult male factor infertility problems have achieved pregnancy at UCSF. Fertilization rates of 70 to 80 percent of all eggs injected – equivalent to fertilization with normal sperm – are currently being achieved, and pregnancy rates are comparable to those seen with IVF in couples with no male factor infertility.

The most important indicator of ICSI success appears to be the fertilization rate achieved with the ICSI procedure. The fertilization rate in the UCSF IVF laboratory is exceptional – currently 80 to 85 percent. That is to say, on average, eight out of every 10 eggs will fertilize normally.

Will all of our eggs be injected?

If you decide to proceed with ICSI, we will make every effort to inject as many eggs as possible. It is important for you to understand that only eggs that are mature can be injected with sperm. Our IVF laboratory can easily tell if an egg is mature or immature. Although the immature eggs are incubated with sperm, the likelihood of fertilization is very low. On average, we are able to inject 75 percent to 80 percent of the eggs that are recovered.

Are there any risks associated with ICSI treatment?

ICSI bypasses many of the processes normally associated with fertilisation, which means that a sperm could fertilise an egg that might not otherwise do so.

The risk of miscarriage or a birth defect is slightly higher with ICSI than with IVF. It appears to increase in proportion to the severity of male infertility and it is thought this factor contributes most to any increased risk, rather than the actual ICSI technique itself.

There have been studies looking at the development of children born after ICSI compared to naturally conceived controls and the data has been very reassuring. Till date  studies support the safety and efficacy of ICSI to treat various male factor conditions.