Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is a micromanipulation technique used during IVF where a single selected sperm is injected directly into the egg cytoplasm to achieve fertilization.
ICSI revolutionised treatment for severe male-factor infertility, including low sperm count, poor motility, or abnormal morphology, and is also used after prior fertilization failure.
The procedure demands specialized embryology equipment and expertise to select viable sperm and perform precise microinjection while preserving oocyte integrity.
Overview And Clinical Background
Microsurgical fertilization for male-factor infertility
ICSI bypasses many natural barriers to fertilization by mechanically inserting sperm into the oocyte.
Developed for cases where conventional insemination fails or sperm numbers/quality are poor, ICSI allows couples to use ejaculated, surgically retrieved or frozen sperm to generate embryos.
It requires fine micromanipulation tools, experienced embryologists and careful post-injection culture.
- Indications: Severe oligozoospermia, asthenozoospermia, teratozoospermia, obstructive azoospermia with retrieved sperm, or previous IVF fertilization failure.
- Also used with PGT or for use of frozen/thawed sperm with limited counts.
- Objective: Achieve reliable fertilization to enable embryo development and transfer where natural or conventional IVF fertilization is unlikely.
Symptoms, Signs And Presentation
Patients typically present with a history of male-factor infertility (abnormal semen parameters), previous unsuccessful IVF cycles or need for use of surgically retrieved sperm.
A multidisciplinary fertility workup guides whether ICSI is the optimal fertilization method.
- Common presentation: Low sperm count, poor motility, abnormal forms on semen analysis or prior failed fertilization attempts.
- Couples using surgically retrieved sperm from testicular or epididymal sources also require ICSI.
- Consideration: Genetic or chromosomal screening may be advised when severe male factor is present to counsel on risks.
Diagnosis Methods And Investigations
Semen analysis and partner assessment
Workup includes repeat semen analysis, infectious screening and evaluation of female partner ovarian reserve.
Where needed, sperm retrieval planning and genetic testing are incorporated prior to ICSI to ensure informed decision-making.
- Semen tests: Conventional semen analysis, retrograde ejaculation assessment, and advanced sperm function testing if indicated.
- Female evaluation: AMH, antral follicle count and uterine assessment to coordinate stimulation and retrieval.
- Genetic counselling: offered when severe male-factor infertility or known genetic issues are present.
Treatment Options And Surgical Techniques
ICSI is performed on the day of egg retrieval: matured oocytes are held under the microscope, a motile or morphologically suitable sperm is immobilized and injected into the oocyte cytoplasm, then embryos are cultured and assessed for transfer or freezing.
When sperm are surgically retrieved, testicular sperm extraction or percutaneous epididymal aspiration is coordinated with the IVF cycle.
- Laboratory technique: Microinjection under high-magnification using micromanipulators and specialized pipettes to minimize oocyte injury.
- Sperm sources: Ejaculated, frozen, testicular or epididymal sperm can all be used depending on the clinical scenario.
- Post-ICSI care: embryos are observed for fertilization and development before selecting for transfer or cryopreservation.
Recovery, Risks And Prognosis
ICSI itself does not add recovery beyond standard IVF cycles.
Fertilization and embryo development rates are typically improved in male-factor cases, though ICSI carries a small increase in some genetic risks related to underlying sperm defects; appropriate genetic counselling mitigates unforeseen outcomes.
Overall live-birth rates with ICSI depend on maternal age, oocyte quality and embryo development.
Why Choose Us
CureU Healthcare’s embryology team uses refined ICSI protocols, high-quality micromanipulation suites and integrated genetic counselling to maximise fertilization and embryo viability while managing risks transparently.
We coordinate sperm retrieval, male evaluation and tailored stimulation for best outcomes.
Conclusion
ICSI is a powerful, precise tool to overcome male-factor infertility and previously failed fertilization, enabling many couples to achieve viable embryos and pregnancy.
When combined with careful laboratory practice and personalised reproductive planning, it delivers meaningful chances for parenthood.
