Its another ART technique where a normal looking sperm is injected into the egg to achieve fertilization with the help of specialized micro equipments.

This technique is of great help to men with poor semen parameters. ICSI has helped many men to become fathers which was impossible otherwise.

Who might benefit by ICSI?

ICSI can offer real hope to couples where the man has a very low sperm count, produces few good-quality sperm, or has a problem with anti-sperm antibodies in his semen. It can also help couples who would prefer not to use donor sperm, as it gives them a greater chance of success using the man's own sperm.

With ICSI, the sperm do not have to travel to the egg or penetrate the outer layers of the egg. This means that it can help men whose sperm cannot move properly or where the sperm can get to the egg, but are unable to fertilize it for some reason.

It is used to help couples where the man has had an irreversible vasectomy, or has no sperm in his semen due to missing tubes or blockages in his reproductive organs.

Couples who have tried IVF can sometimes move on to ICSI if not enough eggs could be retrieved from the woman, or if few of the eggs retrieved for IVF were successfully fertilized in vitro.

Sperm collection from ejaculate or aspirate from the epididymis (PESA) or testis (TESA or TESE) is prepared using special cultured medium. Sperm preparation may also be obtained from frozen semen sample or testicular tissues.

Once the eggs have been selected, a chosen sperm is rendered immotile, then sucked into the tip of a very fine glass needle and injected directly into the egg. The egg is held in place by gentle suction on the opposite side using a holding pipette. This is a very delicate procedure and involves using a micromanipulator. This process is repeated for each egg. The elastic nature of the egg membrane means that the tiny hole made by the needle closes very quickly. About 5% of the injected eggs may be damaged  by the procedure.

ICSI-Treatment outcome

ICSI has now been in use for over 15 years and there are over 26,000 babies already born as a result of ICSI worldwide. The success rates of ICSI treatment are dependent on the skill and experience of the practitioners. Other factors, which also affect ICSI success rates, include the woman's age, duration of infertility and the number of embryos transferred. ICSI does not increase the incidence of multiple pregnancy as compared to standard IVF.

What are the advantages?

This technique opens doors to parenthood that were previously closed to some couples with a male factor fertility problem. ICSI gives men with a very low sperm count or other fertility problems a chance of conceiving their genetic child.

It is possible to use immature sperms that have been retrieved from the man's testicles so ICSI can be used, for example, to help men who have had a vasectomy that cannot be reversed.

ICSI can also be used to help couples with unexplained infertility, but experts have not found that how it makes pregnancy more likely than standard IVF.

What are the disadvantages?

During normal conception, only the hardest sperm manage to travel great distances and break through the membrane of an egg to fertilise it. Weaker sperm never make it. Because ICSI bypasses this process, critics worry about higher rates of miscarriage, and long-term health and development problems for children conceived using whatever sperm are available.

Research to date has been reassuring about most potential risks. No impact seen so far, for example, on the cognitive and motor skills of children conceived using ICSI. However, there is some evidence of an increased risk of structural abnormalities in ICSI babies.