Intracytoplasmic Sperm Injection
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in Fertility Care
Intracytoplasmic Sperm Injection (ICSI) is an advanced fertility treatment used within the process of In Vitro Fertilization (IVF).
Intracytoplasmic Sperm Injection
What is Intracytoplasmic Sperm Injection ?
Intracytoplasmic Sperm Injection (ICSI) is an advanced fertility treatment used within the process of In Vitro Fertilization (IVF).
Unlike conventional IVF, where thousands of sperm are placed around an egg and fertilization happens “naturally” in the lab, ICSI involves an embryologist carefully selecting a single sperm and directly injecting it into the cytoplasm of a mature egg using a fine glass needle under a microscope.
This technique overcomes many barriers that sperm may face in reaching and penetrating the egg. It is especially useful when male infertility factors are present.
When to Consider ICSI ?
Doctors may recommend ICSI in the following cases:
Male-factor infertility
- Very low sperm count (oligospermia)
- Poor motility (sperm don’t swim well)
- Abnormally shaped sperm (teratozoospermia)
- No sperm in ejaculate due to blockage/azoospermia (sperm retrieved surgically from testis or epididymis)
- Retrograde ejaculation (sperm goes into bladder instead of out)
Previous IVF failure
- When conventional IVF was tried but no or very few eggs fertilized.
Egg-related issues
- Older eggs (more difficult to penetrate naturally)
- Frozen or previously preserved eggs that may have a harder shell.
Other reasons
- Couples using surgically retrieved sperm.
- Unexplained infertility where fertilization does not happen naturally.
Variations in ICSI
- Standard ICSI – A single sperm is directly injected into the egg’s cytoplasm
- IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) – Uses very high magnification (up to 10,000x) to select sperm with the best shape and quality before injection. This may improve outcomes in some couples with severe male infertility.
Step Process
Procedure of ICSI
Step 1 : Ovarian Stimulation & Monitoring
- The woman takes fertility medications (gonadotropins) to encourage multiple eggs to grow.
- Progress is tracked with ultrasound scans and blood tests.
Step 2 : Egg Retrieval (Ovum Pick-up)
- About 36 hours after a trigger injection, eggs are collected using a thin needle guided by ultrasound.
- The procedure is done under mild sedation.
Step 3 : Sperm Collection & Preparation
- The male partner provides a semen sample (after 2–3 days of abstinence).
- If sperm cannot be obtained from semen, surgical retrieval is done (e.g., TESA, PESA, or TESE).
- The sample is then “washed” to select the healthiest sperm.
Step 4 : ICSI Fertilization
- Under a high-powered microscope, an embryologist immobilizes and picks a single sperm.
- Using a fine glass needle, the sperm is injected directly into the egg’s cytoplasm.
Step 5 : Fertilization & Embryo Culture
- After ~24 hours, eggs are checked to confirm fertilization (presence of 2 pronuclei).
- Successfully fertilized eggs are cultured for 3–5 days until they become embryos or blastocysts.
Step 6 : Embryo Transfer
- One or two embryos are transferred into the woman’s uterus through a thin catheter.
- Any extra good-quality embryos may be frozen (cryopreservation) for future use.
Results of ICSI
- Fertilization success rate: About 50–80% of injected eggs fertilize successfully.
- Pregnancy rates : Similar to or slightly higher than standard IVF, depending on age and other fertility factors.
Advantages:
- Overcomes severe male infertility.
- Provides fertilization even when sperm quality is poor.
- Helps couples who failed previous IVF cycles.
Considerations :
- Slightly higher lab cost compared to conventional IVF.
- Does not guarantee pregnancy – success also depends on egg quality, sperm DNA integrity, and the woman’s age.
