ICSI (Intra-Cytoplasmic Sperm Injection) has probably been the biggest development in IVF since its introduction in 1992, and the big advantage of ICSI is that as long as some sperm can be obtained (even in very low numbers) it’s possible for a man to be a biological father. This has revolutionised male factor infertility and usually removed the need for donor sperm, which previously was the only option for many couples.
ICSI involves a single sperm being directly injected into an egg to fertilise it, with the fertilised egg then being incubated and transferred to the woman’s womb in exactly the same way as in other IVF procedures. The success rates with ICSI are very similar to general IVF rates and the results from clinics are usually shown together.
ICSI is often recommended when:
- The man has a very low sperm count or absence of sperm in samples
- There are other problems with the sperm, such as poor motility or morphology
- There are known problems with the man’s sperm ability to fertilise an egg (additional semen tests)
- Previous attempts at IVF had either unexpectedly low fertilisation rates or fertilisation failure
- The man’s had a vasectomy and sperm must be surgically collected from the testes or the epididymis (male reproductive organs)
- The man has erectile or ejaculation problems, which often includes men with spinal cord injuries, diabetes and other disorders
- An embryologist will microscopically examine the sperm to decide if ICSI is appropriate
- The preferred option is collecting a fresh semen sample on ‘Egg Collection’ day
- If this isn’t possible there are a number of surgical procedures that can retrieve sperm from the epididymis or testicles; it’s best to discuss these options directly with the andrologist, but the options are:
- ‘Percutaneous epididymal sperm aspiration’ (PESA)
- ‘Testicular sperm aspiration’ (TESA)
- ‘Testicular sperm extraction’ (TESE)
- A single sperm is injected into each egg, which doesn’t guarantee fertilization but it does mean the sperm’s DNA has arrived safely in the egg!
- Between one and three of the best quality embryos will be transferred later
Because ICSI is a relatively recent treatment the possible long-term consequences for the child aren’t fully known, but the risks associated with ICSI so far are: