Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm injection or ICSI, used in conjunction with in vitro fertilization (IVF), has revolutionized the treatment of severe male factor infertility. This procedure involves injection of a single sperm through the outer shell (zona pellucida) and the cell membrane of the egg and into the cytoplasm. ICSI may be required when the male has very low numbers of motile (moving) and/or abnormally shaped sperm, or where there are problems with the sperm penetrating the egg. ICSI also can be effective when there are antisperm antibodies in the semen, (products of the immune system which may otherwise attack and destroy sperm before it can reach the egg), or when previous attempts at fertilization with standard culture systems and fertilization methods were not successful. Finally, ICSI may be used when an infertility cycle relies on a limited number of sperm, including frozen sperm collected prior to cancer treatment, or those obtained from the male’s tissue using microsurgical techniques. Semen analysis and prior history will help us determine whether ICSI is likely to be required as part of your infertility treatment.

The ICSI Procedure

During the ICSI procedure, an embryologist holds the egg in place with a thin pipette (similar to a tiny, glass straw). An injection needle is used to pierce the zona pellucida and inject the sperm. The embryologist then carefully withdraws the needle, leaving the sperm in the cytoplasm of the egg. In less than a minute, the zona closes naturally and the egg retains its normal shape.

ICSI provides substantial benefit in cases of severe male factor infertility; however, there are some risks associated with it. The egg can be damaged during the process and, in some cases, the zona is difficult to pierce. Although there is no data to link ICSI to an increased risk of genetic abnormalities, some evidence suggests that males with semen deficiencies have a higher frequency of chromosomal abnormalities that could be passed on to their male children. As a result, candidates for ICSI are carefully selected and, if necessary, undergo genetic screening and counseling prior to IVF.

If ICSI is successful, it results in fertilization. Even so, the embryo may still face problems related to fertilization in general – it may not divide or it may stop growing at an early stage of development. If it develops normally, it may be selected for transfer to the uterus.