What Is ICSI (Intracytoplasmic Sperm Injection)?
For many couples, the dream of having a baby becomes more complicated when there is a problem with sperm quality. Low count, poor motility or abnormal shape can make natural conception – and even standard IVF – much harder.
This is exactly where ICSI (Intracytoplasmic Sperm Injection) can help.
ICSI is an advanced technique used in the IVF laboratory. Instead of leaving thousands of sperm to “compete” around the egg, the embryologist selects a single, healthy-looking sperm and injects it directly into the egg. For couples facing male factor infertility, ICSI can dramatically improve the chance of fertilization.
How Does ICSI Work?
ICSI is not a separate treatment from IVF – it is a special step inside an IVF cycle. The process for the woman is almost the same as standard IVF:
- Ovarian stimulation – Hormone injections help the ovaries grow several follicles.
- Egg retrieval (OPU) – Mature eggs are collected in a short procedure under sedation.
- Sperm preparation – A semen sample is processed in the lab to select motile, normal-looking sperm.
Then comes the ICSI step:
- Single sperm selection – Under a powerful microscope, the embryologist carefully chooses one sperm for each mature egg.
- Intracytoplasmic injection – Using a very fine glass needle, the sperm is injected directly into the cytoplasm (inside) of the egg.
- Embryo culture and transfer – Fertilized eggs are cultured for 3–5 days, and the best embryo(s) are transferred into the uterus, just like in IVF.
From the patient’s point of view, the experience of ICSI treatment feels very similar to IVF. The main difference happens in the lab.
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When Do Doctors Recommend ICSI?
ICSI is especially useful when there is a clear male factor problem, or when the sperm may have difficulty penetrating the egg on its own. Your fertility specialist may suggest ICSI treatment in situations such as:
- Very low sperm count (oligozoospermia)
- Poor sperm motility (asthenozoospermia)
- Abnormal sperm morphology (teratozoospermia)
- Previous IVF cycle with poor or no fertilization
- Use of frozen sperm, testicular sperm extraction (TESE) or surgically retrieved sperm
- Cases with unexplained infertility where fertilization is a concern
For many couples, hearing that the sperm count is low can feel discouraging. Knowing that ICSI gives each egg a carefully selected sperm often brings relief and new hope.
Benefits of ICSI for Couples with Male Factor Infertility
The main advantage of ICSI is simple: it bypasses many natural barriers that sperm may struggle with.
1. Higher Chance of Fertilization
In classic IVF, sperm need to swim, bind to the egg and penetrate its outer layer. With ICSI, most of these steps are assisted by the embryologist. This often results in higher fertilization rates, especially when sperm quality is poor.
2. Opportunity to Use Very Few Sperm
Even when the semen sample shows extremely low numbers, or sperm has to be collected surgically from the testicle, ICSI can still work because only one sperm is needed per egg.
3. More Control in the Lab
ICSI allows the lab team to choose sperm that look morphologically normal and are actively moving. This extra control is especially valuable in severe male factor cases.
Are There Risks with ICSI?
Like all fertility treatments, ICSI IVF is not completely risk-free. Most babies born after ICSI are healthy, and overall risks are close to those seen with standard IVF. However, important points to discuss with your doctor include:
- A small increase in certain chromosomal or genetic problems may be linked to the underlying male factor infertility, not necessarily the ICSI procedure itself.
- Because ICSI bypasses natural selection, genetic counseling may be recommended if there is a family history of inherited diseases.
- The physical risks for the woman (ovarian stimulation, egg retrieval, pregnancy) are mainly related to IVF in general, not specifically to ICSI.
A good clinic will always explain both the benefits and limitations of ICSI in your particular case.
ICSI vs. IVF: What Is the Difference?
Patients often ask: “Is ICSI better than IVF?”
The answer is: it depends on the cause of infertility.
- In female-factor or purely tubal problems with normal sperm, standard IVF may be enough.
- In male-factor infertility, ICSI IVF usually gives a better chance of fertilization and therefore a better chance of having usable embryos.
Your doctor may even recommend using ICSI on some eggs only, depending on the situation.
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Is ICSI the Right Choice for You?
Choosing ICSI treatment is a personal decision that should be made after a detailed consultation with your fertility specialist. Helpful questions to ask include:
- What is the exact diagnosis of our infertility?
- Why are you recommending ICSI IVF instead of standard IVF?
- What is our estimated chance of success with and without ICSI?
- Are there any extra costs or specific risks we should consider?
See IVF cost in IVF cost in Iran
Understanding what ICSI is, how it works and why it is recommended can turn a very technical procedure into a clear, hopeful step on your fertility journey. For many couples with male factor infertility, ICSI has transformed “almost impossible” into a real, positive pregnancy test.