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What is ICSI? Should I use it for my IVF?

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10 fertility expert(s) answered this question

Answer from: Andrew Thomson, FRCPath

Embryologist, Consultant Clinical Embryologist & Laboratory Manager
Centre for Reproduction and Gynaecology Wales (CRGW)
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ICSI is when there is a male factor issue or previously reduced fertilization from an IVF cycle. So whereas in a conventional IVF cycle what would happen is we would mix the sperm and the eggs together, leave them overnight and check the fertilization the next morning and have some sort of natural selection process. With the ICSI, what we do is, we physically pick up a sperm using a needle and inject that into each of the eggs and that bypasses some of the natural reactions that will happen – normal fertilization, so if the sperm concentration or motility is not where it should be, that can help overcome that first hurdle of fertilization. Now some countries will use ICSI standards 100% of all cycles will be ICSI. The UK tends to be about 50-50. If the sperm parameters are good and it’s your first cycle or you’ve had previously good fertilization, there’s absolutely no need to do ICSI as standard. It should only be used in poor patients with a male factor infertility or where they’ve had a previous cycle and have not had very good fertilization with IVF.

Answer from: Alexia Chatziparasidou,  MSc, PMI-RMP

Embryologist, Consultant Clinical Embryologist, Director of Embryolab Academy, Co-Founder of Embryolab Fertility Clinic
Embryolab Fertility Clinic
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ICSI brought a revolution in the field of assisted reproduction. It was the technique that was first introduced in our clinical practice back in 1992 and it was the technique that gave for the first time the ability or the hope for all men suffering from male infertility. So the first indication for the use of ICSI is male infertility and especially severe male infertility.

Answer from: Andrea Sánchez Freire

Senior Embryologist
ReproMed Ireland
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ICSI Intracytoplasmic Sperm Injection. In this case, we need to strip the eggs to move around the cells of the granulosa and then we need to inject the egg, we select the sperm with the best motility in the microscope and if we can get one sperm into the egg; the race is one less than one minute for the egg.

Answer from: Yacoub Khalaf, Professor

Gynaecologist, Professor of Reproductive Medicine and Surgery at King’s College
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ICSI is a technique where a single sperm is picked up under microscope by the embryologist to inject into the egg. Normally if the sperm has what it takes, it has the right amount, it has the right movement, it has the right shape – you just mix the eggs with the sperm. Usually around a hundred thousand sperm put around one egg and the clever one will penetrate and it will render it invincible and then the following day, we will see signs of fertilization. However, if the sperm was under the weather and a bit weak in movement or few in count or there is issue with their appearance, then it becomes necessary to pick up individual sperm and inject it into individual eggs in what is known as Intracytoplasmic Sperm Injection. It is a fantastic technique for those who need it but there is nothing to be gained by giving it when the sperm is up to doing the job.

Answer from: Daniel Alexander, MUDr

Gynaecologist, Physician
Gennet
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ICSA or Intra-cytoplasmatic Sperm Injection is a micromanipulation method used for fertilization. Years ago when it was invented, it was reserved for couples with a male factor. So, with oligo-, or astheno-, or teratozoospermia, or all together. Nowadays, with the growing age of couples going into fertility treatment, and the lower number and the lower quality of eggs, we recommend and perform ICSI fertilization at each fertilization and on all eggs because ICSI does not guarantee that the egg is fertilized, but it does guarantee that the sperm is inside of the egg, and that increases the chance for fertilization.

Answer from: Alessandra Parrella

Embryologist, Andrologist, Embriologist
IVF-Life Group
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Intracytoplasmic Sperm Injection or ICSI is one of the most used techniques in assisted reproductive technology. With this procedure, a single sperm is injected in each egg using very refined micro manipulation equipment. Intracytoplasmic Sperm Injection is recommended for couples who have been diagnosis with male infertility issues such as low sperm count, low sperm motility or for example, abnormal morphology, also if there is a an anti-sperm antibody test alternated or for couple who have experienced poor or low/none fertilization rate using standard IVF. However, recently I have to say that ICSI has been utilized also in non-male factor cases for instance in women that retrieved a few oocytes or ones that choose to to undergo pre-implantation genetic tests for aneuploidy.

Answer from: George Koustas, DR

Embryologist, Director of Embryology and Quality Manager
Agora Clinic
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ICSI and IVF are two ways of fertilizing eggs in an IVF lab. IVF is simply mixing sperm and eggs together when the sperm quality is good – we allow the eggs and sperm overnight to incubate and then hopefully, the sperm will reach and fertilise the single egg. On the other hand, ICSI, we need to manually pick the single sperm and inject it inside the egg. That maximises the chances of fertilisation taking place as it bypasses any potential problems that the sperm might have to get inside the egg.

Who needs ICSI? This is a big group, I would say that half of the cycles in the IVF lab are ICSI and the reason is that there ICSI is mostly when we have the male factor involved. Meaning by male factor that we have low sperm count (we don’t have enough sperm to perform IVF), we don’t have great morphology of the sperm, when the sperm has high DNA fragmentation index (meaning again it is better to pick and select sperm to fertilise the egg) or in cases that we have frozen eggs when the only way to fertilise them is ICSI.

Answer from: Maria Arquè, MD, PhD

Gynaecologist, Reproductive Specialist
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ICSI is a laboratory technique – the name is an acronym of ‘intracytoplasmic sperm injection’. Whenever we perform an IVF cycle, there are two ways of fertilizing eggs. The first one is called ‘conventional IVF’, and it involves placing an egg in a petri dish of sperm and allowing nature to take care of the rest. ICSI is the other way: in ICSI, we manually select the best-looking sperm (with the best morphology and motility), and we inject it directly into the egg.

It’s difficult to recommend ICSI without knowing the particulars of each case – for some patients, one approach may be better than the other. In general, however, ICSI is indicated in cases where we’re dealing with low-quality sperm or where the patient experienced fertilization failure. Otherwise, either technique can work just as well as the other. It usually falls to the biologist in the lab to decide based on the sperm and egg quality.

Answer from: Victoria Walker, MD

Gynaecologist, Fertility Specialist
Institut Marquès
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What is ICSI, and should I use it for my IVF? Imagine a woman undergoing IVF. If we collect her eggs, we have two main options for fertilization. The first one is putting the eggs in a bath of sperm and simply watching as they fertilize naturally. Alternatively, we can look at the sperm sample under a microscope to find a single sperm that looks the best – we would be looking for a sperm, which has a normal shape, one head, not too big, not too small, one tail – not two, not three – swimming fast and not just standing in place, et cetera. We would then take that sperm and inject it directly into the egg. That second option is called ICSI.

ICSI was initially developed for men with poor sperm quality, and it’s still used for that reason today. However, nowadays, many clinics use ICSI to improve their fertilization rates in all scenarios. Up until ten, fifteen years ago, specialists were worried that some rare abnormalities detected in children born through IVF may be caused by ICSI. What they found out, however, is that ICSI is not the cause. Defects may be rather caused by abnormalities in the sperm. The technique itself does not seem to be problematic.

Who should use ICSI? Like I mentioned, it tends to be used in men with low-quality sperm, as well as those who don’t produce any sperm within their ejaculate, but who do have sperm inside their testes. There are also some female factor-related scenarios in which IVF ICSI may be recommended. For instance, for women undergoing IVF who are only able to produce one or two eggs per cycle, ICSI maximizes the fertilization rate. Those who produce eggs with very thick shells are also candidates for the procedure. In general, we would also recommend ICSI to those who tried conventional fertilization without success, as well as those who underwent several IVF cycles without success. Patients who plan to perform PGT-A testing also should consider ICSI, as in that case, maximizing the number of embryos is a priority.

Answer from: Pilar González Dosal

Embryologist
IVF-Life Group
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The intracytoplasmic sperm injection (ICSI) technique involves the injection of a single sperm into each mature oocyte, using micro-manipulation equipment and under direct microscopic vision. It is a safe and standardized technique performed by highly experienced embryologists. After egg retrieval, we prepare the eggs by removing the cells that surround the oocyte in a process called “decumulation”. This allows us to see if the eggs are mature – mature oocytes are required for ICSI.

At the same time, we prepare the semen sample. We look for the best sperm – both in morphology and motility – before performing the microinjection. Once we have everything ready, we proceed with the technique. The entire process takes place approximately 4 hours after egg retrieval. By the following day, we’re able to check the eggs and see which ones have been fertilized.

At first, ICSI was developed to overcome severe forms of male factor infertility. Nowadays, however, it is the most used technique in assisted reproduction. ICSI is a routine clinical practice in fertility centres worldwide, used in approximately 80% of all IVF treatments performed. ICSI enjoys a high fertilization rate (around 80%), which in turn, leads to more high-quality embryos and higher pregnancy rates. The technique is essential when an altered male factor is present because a low quality sperm sample will not be able to fertilize the oocyte on its own.

There are other situations in which it is also advisable to carry out ICSI: For instance, it is essential in cases when the sperm is obtained by testicular aspiration or a biopsy because, in most of these cases, we have very few sperm cells available. ICSI is also required when dealing with vitrified or frozen oocytes. This is because, before vitrifying, we have to decumulate the eggs, making conventional IVF impossible. Finally, it is also necessary to do ICSI in a PGT treatment, as in those scenarios, removing all the cells around the egg is necessary to avoid contaminating the biopsy sample.

One of the advantages of ICSI is that it allows us to avoid fertilization failures since the sperm is introduced directly into the cytoplasm of the oocyte. This is something that can not happen if conventional IVF is performed, even when using a normozoospermic sperm sample. Because of this, it is also advisable to perform ICSI when we have valuable sperm and oocyte samples, which have been preserved due to cancer or other health problems.

About this question:

What is it and why is ICSI used? More importantly, who will benefit from this procedure?

ICSI is an intracytoplasmic sperm injection. To know more about ICSI, have a look at our experts’ answers about the procedure itself and its use.

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