The procedure called intracytoplasmic sperm injection, commonly referred to as ICSI, is an advanced reproductive technique that takes place during an IVF cycle. The procedure consists of the injection of a single sperm cell directly into an egg under the microscope. This technique is usually used when a male factor has been identified as the cause of infertility. ICSI is usually recommended when there is an abnormality with sperm, including: low or no sperm count, low motility or abnormally shaped sperm (low morphology). Poor fertilization in a previous IVF cycle or low egg number may also prompt the use of this technique.
In order to undergo the ICSI procedure, the female patient must undergo the usual IVF therapy to induce the production of many eggs. The male partner will provide a semen sample by masturbation, in which the healthiest looking sperm will be isolated. In cases when there are no sperm available due to idiopathic azoospermia, spinal cord injury or vasectomy, sperm could be retrieved directly from the testicle through a simple outpatient surgical procedure called: microdissection, testicular sperm extraction (TESE) or biopsy and percutaneous sperm aspirations (PESA) from the epididymis. The sperm extraction usually takes place around the time of the egg retrieval.
In the IVF lab, the embryologist uses a micromanipulator to hold the egg in place and in a proper orientation. Then, a small hole is made in the egg membrane using microscopic tools and the sperm is inserted directly into the cytoplasm of each egg. After the insertion of the sperm has taken place, the eggs are placed in incubators that facilitate their development. If fertilization occurs, the healthiest embryos will be transferred into the female’s uterine cavity. A blood test is performed about two weeks later to determine if the patient is pregnant.
The ICSI technique has been used in the IVF lab for many years. To date, there is no association with an increase risk of birth defects. Additional indications to the use of this procedure, besides moderate to severe male factor infertility, include: advanced reproductive age, unexplained infertility, previously failed vasectomy reversal and the presence of sperm antibodies in a man’s semen.