Around a third of cases of infertility are related to the sperm quality, and ICSI is one of the main techniques used in IVF to help overcome this. ICSI was introduced as a clinical treatment for infertility in 1992 and is now used in approximately half of all IVF procedures performed in the UK.
While the rest of the IVF treatment remains the same – the woman taking fertility drugs to stimulate the ovaries, monitoring the follicle growth with scans and blood tests as required, then performing a collection to retrieve the eggs – the difference comes at the fertilisation stage.
ICSI involves the injection of a single sperm directly into each mature egg that has been collected. Not all eggs will be of a high enough quality or mature enough to be suitable for injection. It is also possible that some eggs may not survive the injection process. It is also possible that some eggs, despite being mature, and being injected with sperm will still not fertilise.
However, on average 60-70% of eggs do achieve fertilisation no matter how poor the sperm appear to be. The fertilised egg (embryo) can then be transferred into the uterus (womb) of the woman or frozen as in a normal IVF
cycle.
Circumstances in which ICSI may be appropriate include:
● When the sperm count is low
● When the sperm cannot move properly or are in other ways abnormal
● When the sperm has been retrieved directly from the epididymis (PESA) or
the testicles (TESA/ TESE), from the urine, or by electro ejaculation
● When there has been a previous IVF attempt resulting in failed or low
fertilisation
The decision to perform ICSI is sometimes confirmed on the day of egg collection and is dependent on the quality of the sperm sample. If your sperm is of a borderline quality, we may suggest that a proportion of eggs undergo ICSI and the rest are inseminated conventionally. If fertilisation is achieved in both groups of eggs, you will know that ICSI is not necessary should you need further treatment in the future. This option is only advised if a reasonable number of eggs are collected.