ICSI (Intra Cytoplasmic Sperm Injection) refers to the injection of a single sperm into the egg as a means of facilitating fertilization. ICSI became a clinical tool about 1992 , and its use revolutionized the treatment of male infertility.
Because of its effectiveness in helping infertile couples become pregnant, ICSI might be considered the second most important advance in infertility care. IVF treatments alone do not correct the problem when men have defective sperm.
ICSI is often used when male infertility conditions such as poor sperm quality or a low sperm count prevent fertilization, or when previous attempts at IVF fertilization have failed.
Unlike many fertility centers, we do not charge an additional free when ICSI is needed.
Pregnancy success rates for IVF procedures with ICSI have been shown in some studies to be higher than IVF without ICSI. This is because in many of the cases needing ICSI the female is relatively young and fertile (good egg quantity and quality) as compared to some of the women having IVF for other reasons.
In other words, the average egg quantity and quality tends to be better in ICSI cases (male factor cases) because it is less likely that there is a problem with the eggs – as compared to cases with unexplained infertility. Some unexplained cases have reduced egg quantity and/or quality – which lowers the chances for a successful IVF outcome.
IVF with ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician.
Sometimes IVF with ICSI is done for “egg factor” cases – low ovarian reserve situations. This is when there is either a low number, or low “quality” of eggs (or both). In such cases, ICSI fertilization and pregnancy success rates tend to be lower. This is because the main determinant of IVF success is the quality of the embryos. The quality of the eggs is a crucial factor determining quality and viability of embryos. In some cases, assisted hatching is done on the embryos prior to transfer, in order to maximize chances for pregnancy.
Preceding ICSI was PZD (Partial Zona Dissection) and SUZI (SUb-Zonal Insemination). However, neither of these techniques actually improved severe male factor infertility. Intracytoplasmic Sperm Injection was the technique that allowed very poor or rare sperm to be capable of fertilizing and egg.
PZD was a technique whereby the embryologists created a hole in the zona to allow the sperm easy access to the egg membrane. SUZI was a technique where one or more sperm were placed between the zona and the egg membrane. Unfortunately the fertilization rate was really not much different from that achieved with conventional IVF insemination. Men with failed fertilization did not do much better with these techniques.
While ICSI has been a miraculous treatment advance, it may have also “dumbed down” male infertility care. If the sperm analysis is abnormal then many couples are directed to IVF/ICSI very quickly when they may have alternatives. Further, many IVF cases only require conventional insemination. It is easier for many clinics to do ICSI than to determine whether the sperm is normal for conventional insemination.
For example, most statistics suggest that male infertility is present in about 30-40% of couples. One would think that conventional insemination would be adequate for the other 60-70% of cases.
This data shows that while the incidence of male factor in IVF cases remains stable at about 35%, the US national trend for ICSI has significantly risen from 35% in 1997 to over 60% in 2008 when the study was published. We have not seen the numbers decrease.
Further, the liveborn delivery rate is generally lower if ICSI is used when there is no male infertility factor present. The decrease is about 2-5%. The oldest patients may benefit from ICSI without a male factor but they represent a small portion of the IVF cycles.