Infertility treatment: Intracytoplasmic Sperm Injection (ICSI)

ICSI 3D video - Intra Cytoplasmic Sperm Injection - Steps , Process.ARC Fertility Hospitals (June 2019).


the ICSI (intracytoplasmic Sperm injection) is a procedure that can be used as part of an IVF (in vitro fertilization) treatment. It was introduced in 1992 and welcomed as a breakthrough in fertility treatments where the problem was male.

Since that time, ICSI has been the most successful method of treating male infertility and has replaced other methods such as SUZI (Subzonal Spermatozoa Injection), which gave sperm a head start by being injected through the outer shell.

ICSI requires only one sperm that is injected directly into the egg. ICSI is now used in almost half of all IVF treatments (HFEA n. D.).

Who can benefit from it?

ICSI can give real hopes to couples with low sperm counts, low quality semen, or semen antibody issues in their semen (HFEA 2007). It can help couples who prefer not to use donor sperm.

In ICSI, semen does not have to move to the oocyte and penetrate its outer shell. This means that it can help men whose sperm can not move properly, or where the sperm reaches the egg, but for some reason can not penetrate it.

The method is also used to help couples in whom the man has an irreversible vasectomy (seminal vas deferens) or no sperm in his ejaculation due to missing duct (duct). This method can also be used for blockages in the internal sex organs or production problems in the testes - after a successful sampling from the testicular tissue.

couples who have tried IVF can try ICSI if it did not work (HFEA 2007).

Is ICSI suitable for all male fertility disorders?

Some men have a small amount of sperm because of a genetic problem. The so-called azoospermia factor (AZF) lacks information on the Y chromosome. This problem is inherited by every son conceived by ICSI. Therefore, a blood test is often recommended before the start of an ICSI cycle (HFEA 2006) to detect such problems.

Responsible physicians will provide expert care to patients who may be affected before and after the test, and explain the results during genetic counseling prior to ICSI treatment (NCCWCH 2004: 120).

How is it done?

During an IVF treatment, the woman is given medication to stimulate her ovaries to produce several mature oocytes for fertilization. (Women usually have only one fertile oocyte a month.) When the eggs are mature, the husband and wife undergo different procedures. For example, the man produces a sperm sample by masturbating in a cup. If semen is not present in the semen, doctors will in most cases take it directly from the testicle with a needle under anesthesia.

If this does not produce enough sperm, the doctor will do a biopsy of the testicular tissue that sometimes contains sperm. This procedure is called Testicular Sperm Extraction (TESE). It is sometimes done before the treatment cycle begins. The sperm obtained is frozen. After the woman has received a brief anesthetic, the doctor removes her oocytes with a fine hollow needle by puncture through the vagina into the follicles. (Ultrasound helps the doctor locate the follicles.) Then the sperm is isolated and injected under the microscope into individual oocytes. One day later you can see if the fertilization worked. It forms cell clumps, which are called embryos.

The rest of the procedure includes the same steps as with IVF. The doctor transfers the embryos to the woman's uterus using a thin catheter through the cervix. A maximum of three embryos can be transferred (the older the woman, the more you transfer). Additional fertilized eggs in the pronuclear stage can be frozen in case this cycle is unsuccessful.

The embryo can attach itself to the uterine wall and continue to grow. After about two weeks, the woman can do a pregnancy test.

How long does the treatment take?

A complete ICSI cycle takes four to six weeks. You and your partner to spend a full day at the clinic for removal of the egg and the sperm and another, so that embryos can be transferred between two and five days later.

What is the success rate?

The average national pass rate for ICSI in women under the age of 35 is approximately 26.7 percent (2007 Yearbook of the German IVF Registry).

What are the advantages of the method?

This method gives some couples with a fertility disorder the opportunity to become parents. This possibility did not exist before. ICSI gives men with a low sperm count or other fertility problems the chance to father their own genetic child.

It is possible to use immature sperm derived from the man's testicles, for example, to help men who had a vasectomy that can not be reversed (NCCWCH 2004: 50, 109).

What are the disadvantages?

Because ICSI circumvents the natural process of procreation, critics worry about a higher rate of miscarriages, long-lasting health problems, and difficulties in developing children conceived with whatever sperm was available (HFEA 2006) ).

The results of research are reassuring for most potential risks. So far, for example, no impact has been identified on the cognitive and motor skills of children conceived by ICSI (Ponjaert-Kristoffersen et al 2005). However, there is some evidence of an increased risk of structural abnormalities in ICSI babies.

A large-scale international study has found that 4, 2 percent of all ICSI babies have major malformations that primarily affect boys' urinary and gender systems (Bonduelle et al 2005). The risk of malformation was almost three times higher in ICSI babies than in babies born naturally.

The same study found that the likelihood for children receiving ICSI and standard IVF to have a serious childhood illness, medical procedure or surgery up to the age of five is much greater than in children who have were naturally conceived (Bonduelle et al 2005).

In a 1997 study conducted throughout Germany, 2,687 pregnancies (with 3,372 children) were performed using the ICSI method; a matched control group with spontaneous pregnancies was evaluated in parallel by the Mainz birth registry. Here, a rate of large malformations of 8.63% was found in ICSI-fathered children compared to 6.77% in the control group. The malformations mainly concerned diseases of the cardiovascular system and the external genitourinary tract. The resulting relative risk is 1.27 percent. This means that in the case of normal pregnancies, one in five children and one ICSI in the worst case would be likely to cause a malformation in every 12 children (Ludwig 2010).

Parents of babies born with the help of ICSI are also concerned about the future fertility of their child (Fisher-Jeffes et al 2006). But the method has not been used long enough to say if this will be a big problem for ICSI babies when they grow up.

Much more research is needed before all the risks associated with ICSI are known. In the meantime, many women who have received this method regularly undergo ultrasound examinations at the beginning of pregnancy to monitor the development of the baby. If you are worried, talk to your consulting doctor.

Our expert: Dr. med. Robert Fischer from Fertility Center Hamburg.He is a gynecologist specializing in gynecological endocrinology and reproductive medicine, in particular assisted reproduction.

Would you like to talk to others about ICSI? Then go to our community.


Bonduelle M, Wennerholm UB, Loft A, Tarlatzis BC, Peters C, Henriet S, Mau C, Victorin-Cederquiest A, Van Steirterghem A, Balaska A, Emberson JR, Sutcliffe AG. 2005. A multi-center cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception.

Hum Reprod

. 20 (2): 413-9. Fisher-Jeffes LJ, Banerjee I, Sutcliffe AG. 2006. Parents' concerns about their ART children. Reproduction

. 131 (2): 389-94. HFEA. n. d. Facts and figures. (Based on treatment carried out between 1 Apr 2003 and 31 Mar 2004). Human Fertilization and Embyrology Authority. www. HFEA. gov. uk [as of May 2007] HFEA. 2006. What is ICSI? London: Human Fertilization and Embryology Authority. www. HFEA. gov. uk [as of May 2007]

HFEA. 2007. Infertility 2007/08: The HFEA guide. London: Human Fertilization and Embryology Authority. www. HFEA. gov. uk [pdf file 998 KB, opens in a new window] [as of May 2007]

Ludwig 2010. Priv. Dr. Doz. med. Michael Ludwig, Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital Lübeck, German Society for Gynecology and Obstetrics e. V.

NCCWCH. 2004.

Fertility: assessment and treatment for people with fertility problems - full guideline.

National Collaborating Center for Women's and Children's Health. London: RCOG Press. www. rcog. org. uk [PDF 1. 24MB; As of August 2009] Ponjaert-Kristoffersen I, Bonduelle M, Barnes J, Nekkebroeck J, Loft A, Wennerholm UB, Tarlatzis BC, Peters C, Hagberg BS, Bernese A, Sutcliffe AG. 2005. International collaborative study of intracytoplasmic sperm injection-conceived, in vitro fertilization-conceived, and naturally conceived 5-year-old child outcomes: cognitive and motor assessments. Pediatrics

. 115 (3): 283-9. Priv. Dr. Doz. med. Michael Ludwig, Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital Lübeck, German Society for Gynecology and Obstetrics e. V. Show sources Hide sources

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