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What is ICSI?
ICSI, which is pronounced ick-see, stands for intracytoplasmic sperm injection. ICSI may be used as part of an IVF treatment.
In normal IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg. With ICSI, the embryologist takes a single sperm and injects it directly into an egg.

Why is ICSI Done?
ICSI is typically used in cases of severe male infertility, including:

  • Very low sperm count (also known as oligospermia)
  • Abnormally shaped sperm (also known as teratozoospermia)
  • Poor sperm movement (also known as asthenozoospermia)

If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE. Sperm retrieved through TESE require the use of ICSI.
ICSI is also used in cases of retrograde ejaculation, if the sperm are retrieved from the man’s urine.
ICSI may also be done if regular IVF treatment cycles have not achieved fertilization.

What is the Procedure for ICSI?
ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won’t seem much different than an IVF treatment without ICSI.
As with regular IVF, you’ll take ovarian stimulating drugs, while your doctor will monitor your progress with blood tests and ultrasounds. Once you’ve grown enough good-sized follicles, you’ll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle.
Your partner will provide his sperm sample that same day (unless you’re using a sperm donor, or previously frozen sperm.)
Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved.
If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval.
You can get more detailed information here in this IVF Treatment Step by Step.

How Much Does ICSI Cost?
ICSI typically costs between $1,000 to $1,500. This is on top of the general IVF cost, which on average costs $12,000 to $15,000. It may cost more than this if other IVF options are being used.

Is ICSI Safe for the Baby?
A normal pregnancy comes with a 1.5% to 3% risk of major birth defect. While ICSI treatment carries a slightly increased risk of birth defects, it’s still rare.
Some birth defects which have an increased risk with ICSI include Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, and sex chromosome abnormalities. Still, they occur in less than 1% of babies conceived using ICSI with IVF.
There is some increased risk of a male baby having fertility problems in the future. This is because male infertility may be passed on genetically.

What is the Success Rate for ICSI?
The ICSI procedure fertilizes 50% to 80% of eggs. (Interestingly, just because a sperm is injected into an egg, it does not guarantee fertilization will happen.) Even if fertilization takes place, the embryo may stop growing.
However, once fertilization happens, the success rate for a couple using ICSI with IVF is the same as a couple doing regular IVF treatment.

What Can ICSI Help Treat?
There are a variety of underlying fertility conditions that ICSI may help treat. The specific male fertility problems that ICSI is used to treat are:

  • low sperm count
  • low sperm motility
  • total absence of sperm in the semen
  • damaged or absent vas deferens
  • retrograde ejaculation
  • irreversible vasectomy
  • immunological factors (such as a very high white blood cell count in the semen)
  • other conditions that prevent the fertilisation of the egg

Men who have been diagnosed with testicular cancer may also want to consider freezing a semen sample prior to treatment since this sample can later be used in ICSI.

How ICSI Works
Since ICSI is always used with in vitro fertilisation, the process starts with preparation for this procedure. The woman is given fertility drugs to stimulate egg follicle development and ovulation. Her mature ova are then retrieved to use during ICSI.
In additional preparation for ICSI, sperm is collected from the man. In cases where it is possible, sperm can be collected from a semen sample. This is the preferred method since it is less invasive, but for some men this may not be possible. An alternate option is to harvest the sperm directly from the man's testicles using a testicular biopsy under anesthetic.
The single sperm is then injected directly into the woman's harvested egg with a very delicate needle. The egg will reseal itself after the needle is withdrawn, just as it does in the process of natural fertilisation when the sperm breaks through its outer membrane.
As in in vitro fertilisation without ICSI, the fertilised egg is then allowed to develop for a few days before being transferred back into the woman's uterus in the form of an embryo.

Effectiveness of ICSI
ICSI is currently the most successful treatment for male infertility, with fertilisation rates of 60%-70% depending on quality of the sperm used. However, once the egg is fertilised, the success rates of ICSI in conjunction with IVF remain the same as conventional IVF – a 20%-25% chance of live birth. This is because overall effectiveness still depends on the fertilised egg developing properly in addition to successful implantation into the uterus. In some cases, assisted hatching may be used to increase the chances of implantation.

ICSI Risks
One concern about ICSI is the possible health impact of this procedure on any resulting children. ICSI is often used with men who have poor sperm quality, and the method entails using any sperm to fertilise the egg as opposed to the strongest one (which is what happens in nature). Because it is possible that a weaker, poorer quality sperm might be used in ICSI, congenital defects may be passed on at a higher rate than naturally or with other methods of IVF.
Also, because ICSI is a relatively new procedure, the long-term effects for resulting children have yet to be properly analyzed. So far, no studies have shown any increased chance of physical, developmental, or congenital problems in children conceived using ICSI.
Couples who want to conceive using ICSI are still advised to analyze their family history for genetic diseases and disorders and consult with a doctor. They may also want to consider pre-implantation genetic diagnosis (PGD).
Finally, because ICSI is used in conjunction with IVF, the risks of IVF apply here too; namely, increased chances of ectopic pregnancy and multiple births.
However, ICSI is still a viable choice if done by a reputable clinic. For some facing the only other alternatives of adoption, sperm donors, or never having children, the risks if ICSI pale in comparison to the possible benefits.


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female infertility
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ICI in kerala
ICSI videos
Infertility and ICSI
IVF Guide
About Surrogacy
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Who Donate the Egg
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What is embryo?
Low Sperm count