Intra Cytoplasmic Sperm Injection (ICSI) is a laboratory procedure developed to help infertile couples undergoing In Vitro Fertilization (IVF) due to severe male factor infertility. ICSI involves the insertion of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a special microinjection pipette (glass needle). After sperm injection into the egg, further culture and embryo transfer is as with the IVF cases. For patients with subfertile semen, this procedure is preferable to IVF.

ICSI can facilitate fertilization by sperm that will not bind to or penetrate an egg. It can also be used to treat men with extremely low numbers of sperm. However, ICSI is generally unsuccessful when used to treat fertilization failures that are primarily due to poor egg quality.

Indications for Intra Cytoplasmic Sperm Injection

• Oligospermia – very low sperm counts
• Asthenozoospermia – poor sperm motility
• Teratozoospermia – too many abnormal sperms
• Problems with sperm binding to and penetrating the egg
• Antisperm antibodies (immune or protective proteins which attach and destroy sperm) of sufficient quality to prevent fertilization
• Prior or repeated fertilization failure with standard IVF culture and fertilization meth
• Frozen sperm collected prior to cancer treatment that may be limited in number and quality
• Azoospermia with obstructive pathology – absence of sperm secondary to blockage or abnormality of the ejaculatory ducts that allow sperm to move from the testes. In this situation, sperms are obtained from the epididymis by a procedure called microsurgical epididymal sperm aspiration (MESA) or from the testes by testicular sperm extraction (TESE).

Thus very few azoospermic men need to resort to a sperm bank now with the availability of ICSI.

ICSI is not a perfect technique. Some eggs will be damaged by the ICSI process. Some eggs have plasma membranes that are difficult to pierce. In other instances, the fertilized egg may fail to divide, or the embryo may arrest at an early stage of development.

Perinatal outcome studies in Europe suggest that although multiple pregnancies are common with ICSI, there is no evidence of increased incidence of congenital malformations or abnormal karyotype. There is no evidence that abnormalities may arise later in life to babies born as a result of ICSI, although there is also no guarantee that all babies will be normal.