Physiological intracytoplasmic sperm injection (PICSI) is a technique used to select sperm to use in ICSI treatment. It involves placing sperm with hyaluronic acid (HA), a natural compound found in the body. PICSI identifies sperm that can bind to HA and these sperm are selected for use in treatment. PICSI is a non-invasive procedure performed on a semen sample as an additional step in the ICSI process. Risks associated with the use of ICSI also apply to PICSI; there are no significant additional risks to the patient or embryo.

PICSI has been deemed as ‘Red’ under the HFEA traffic light system due to no significant evidence showing that it is effective and safe. Several studies have been conducted to compare ICSI and PICSI but no significant evidence has been found to prove any benefit of using PICSI as a treatment add-on. For example, a recent large randomised controlled trial (RCT) (Miller, 2019) demonstrated that PICSI does not significantly increase chances of live birth. Some secondary evidence has been found to demonstrate that PICSI might reduce miscarriage rate. However, due to this being a secondary outcome from an RCT and not the primary aim of that study, these results are less reliable. King’s Fertility offers PICSI to some patients and only after doctor’s recommendation at no additional cost to ICSI.