Fertility Treatment Options : ICSI and IVF for Male Infertility, Sperm Injection Into Eggs

Intracytoplasmic sperm injection (ICSI) can be used as part of an in vitro fertilisation (IVF) treatment to help you and your spouse to conceive a child. 

ICSI is the most successful form of treatment for men who are infertile and is used in nearly half of all IVF treatments. 
ICSI only requires one sperm, which is injected directly into the egg. The fertilised egg (embryo) is then transferred to your uterus (womb).

Common reasons used for performing ICSI

1.     Severe male factor infertility that do not want donor sperm insemination.

2.     Couples with infertility with:

o    Sperm concentrations of less than 15-20 million per milliliter

o    Low sperm motility - less than 35%

o    Very poor sperm morphology (subjective - specific cutoff value is debatable)

3.     Having previous IVF with no fertilization - or a low rate of fertilization (low percentage of mature eggs that were normally fertilized).

4.     Sometimes it is used for couples that have a low yield of eggs at egg retrieval. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (mixing eggs and sperm together).

How is ICSI performed?

1.     The mature egg is held with a specialized holding pipette.

2.     A very delicate, sharp and hollow needle is used to immobilize and pick up a single sperm.

3.     This needle is then carefully inserted through the zona (shell of the egg) and in to the center (cytoplasm) of the egg.

4.     The sperm is injected in the cytoplasm and the needle is removed.

5.     The eggs are checked the next morning for evidence of normal fertilization.

How long does ICSI treatment last?

One cycle of ICSI takes between four weeks and six weeks to complete. You and your spouse can expect to spend a full day at the clinic for the egg and sperm retrieval procedures. You'll go back anywhere between two days and six days later for the embryo transfer procedure.

What are the success rates of ICSI?

The success rates for ICSI are higher than if you use conventional IVF methods. A lot depends on your particular fertility problem and your age. The younger you are, the healthier your eggs usually are, and the higher your chances of success. 
The percentage of cycles using ICSI which result in a live birth are:

• 35 per cent if you are under 35
• 29 per cent if you are between 35 and 37
• 21 per cent if you are between 38 and 39
• 14 per cent if you are aged between 40 and 42
• six per cent if you are between 43 and 44
• five per cent if you are over 44

What are the advantages of ICSI?

• ICSI may give you and your spouse a chance of conceiving your genetic child when other options are closed to you.
• If your spouse is too anxious to ejaculate on the day of egg collection for standard IVF, sperm can instead be extracted for ICSI.
• ICSI can also be used to help couples with unexplained infertility, though experts haven't found that ICSI makes pregnancy any more likely than standard IVF.
• ICSI doesn't appear to affect how children conceived via the procedure develop mentally or physically
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