What’s Intracytoplasmic Sperm Injection?
Intracytoplasmic sperm injection, or ICSI, is a technique that’s sometimes used as part of in vitro vertilization (IVF). It’s used in cases in which the man’s sperm have trouble fertilizing the woman’s egg; this could be because his sperm count is very low, or because his sperm have poor motility or shape and are not able to fertilize effectively. ICSI is fertilization of an egg by a sperm in the laboratory.
If you’re choosing ICSI, make sure you’re choosing it because you really want it, not to please someone else or to fit an imagined ideal. No one else can make the choice for you; it’s your body, and you’re in charge of it. After you do your research and understand the procedure, if you believe that ICSI is right for you, then proceed. To help you in your decision-making process, we have some information about the risks and benefits of having ICSI at Intracytoplasmic Sperm Injection (ICSI): Risks and Benefits.
Please note that this page is for informational purposes only, and is not a substitute for qualified, individualized medical advice. You should discuss your potential elective procedure with your own doctor(s), including your primary care physician and the doctor who will perform your procedure if you decide to proceed.
How it’s done
Some centers perform ICSI routinely, as part of IVF. At other centers, the choice of whether or not to use ICSI is made collaboratively between the physician and the patients, and is determined by the couple’s medical situation. There may be an extra charge for ICSI, and it may or may not be covered by insurance (even if IVF is); for some couples, this financial consideration may be part of the decision of whether or not to use ICSI.
ICSI is done during the insemination (fertilization) phase of IVF. (For more information about the various steps of the IVF procedure, which is complex, please visit our page called In Vitro Fertilization (IVF): the Procedure and Recovery.) In a non-ICSI cycle of IVF, after the eggs are retrieved from the woman’s body, they are mixed with sperm, and fertilization happens naturally. In order for natural fertilization to occur, the sperm must make its way through the zona pellucida (the hard shell of proteins that encloses the egg) and through the egg’s cell membrane into the inside of the egg (called the cytoplasm). This process is naturally difficult; the difficulty reduces the chances of the egg being fertilized by more than one sperm, which would make the resulting embryo inviable.
In some cases, the sperm have trouble with this part of the cycle. The sperm may be poorly motile or abnormally shaped, or the sperm count may be extremely low. ICSI is assisted fertilization. To perform ICSI, a technician uses a small instrument to stabilize the egg. Then a very small needle is used to inject one sperm directly into the egg’s cytoplasm, fertilizing the egg.
After ICSI, the rest of the cycle proceeds just like any other IVF cycle. The embryos are incubated for several days while being monitored, and then one or a few healthy embryos are selected for transfer into the woman’s uterus, where the hope is that they will implant and produce a pregnancy.
Preparing for the procedure
Choosing your clinic
When choosing an assisted reproductive technology clinic (sometimes called a fertility clinic), there are several factors you may want to take into consideration. One is the physician(s) and others who will oversee your care. Make sure that your physician is board-certified; you may want to know that a board-certified reproductive endocrinologist (a specialist in the hormones involved in reproduction) is on the staff, as a consultant if necessary. You should also expect that your clinic will be a member of the Society for Assisted Reproductive Technology (SART), and follows the guidelines of the American Society for Reproductive Medicine (ASRM). You might also want to consider the clinic’s success rates, which are collected and published by the Centers for Disease Control (CDC), but you should be aware that interpreting this data is more complicated than you might think.
For more help in your search for a reproductive medicine specialist, visit our How to Find the Best Assisted Reproductive Technology Clinic page. At Doctor Review, you can also search providers for patient reviews to help you find the very best.
Getting ready for the procedure
Before going through IVF with or without ICSI, both the man and the woman will have several diagnostic procedures, blood tests, and examinations. In some cases, other types of infertility treatment, such as ovulation induction (stand-alone; this is also part of IVF) or intrauterine insemination, may be done first, and IVF will only be necessary if these are unsuccessful. In some cases, one or more cycles of IVF without ICSI may be attempted before ICSI is used. In other cases, ICSI will be used during every cycle of IVF.
The recovery from a cycle of IVF that uses ICSI is the same as for a non-ICSI cycle. See the IVF page for more details.