Intra-Cytoplasmic Sperm Injection (ICSI) is the most significant development in modern male fertility treatment and has enabled tens of thousands of men to be biological fathers.
Men with low sperm counts, high numbers of abnormal sperm, or whose sperm are unable to bind to (and fertilise) eggs can bypass all these barriers to conception by having their sperm inserted into an egg physically. The technique has revolutionised male factor infertility and significantly reduced the use of donor sperm, which was the only option available to couples with male factor fertility issues previously.
The procedure involves collecting healthy-looking sperm and injecting one directly into an egg to fertilise it. The fertilised egg is then incubated and transferred to the woman’s womb in the same way as in other IVF procedures, and ICSI success rates are similar to general IVF rates. Male factor is a significant (and often difficult to detect) issue in many couples attending IVF clinics, and as most IVF cycles now involve the technique, ICSI outcomes are rarely shown separately.
ICSI is recommended whenever:
- Men have low sperm counts or no sperm in semen samples (oligospermia)
- Semen samples have few normal sperm or very poor motility (teratozoospermia and asthenozoospermia)
- The man’s sperm are unable to fertilise an egg (additional semen tests)
- Previous IVF cycles had either unexpectedly low fertilisation rates or failure
- A vasectomy requires the surgical collection of sperm from the testes or the epididymis (male reproductive organs)
- The man has erectile or ejaculation problems from spinal cord injuries, diabetes or some other cause
Procedure
- Semen samples are assessed to decide if ICSI is appropriate
- The preferred option is a fresh semen sample on “Egg Collection” day
- When this isn’t possible, there are surgical procedures to retrieve sperm
- One sperm is injected into each egg, which doesn’t guarantee fertilisation, but it does bypass many potential barriers to conception
- Between one and three of the best-quality embryos will be transferred later
Surgical options
When it’s impossible to get healthy-looking sperm from semen samples, there are ways to retrieve sperm from the tubes around the testicles or testicular tissue. The options are:
- Percutaneous epididymal sperm aspiration (PESA)
- Testicular sperm aspiration (TESA)
- Testicular sperm extraction (TESE)
The ideal scenario is to get mature sperm from the epididymis with PESA rather than retrieving sperm from the testicles.
Risks
ICSI is a relatively recent treatment, and the men involved have low fertility that may be passed on or be a marker for other traits. No one knows the possible long-term consequences for each child, but the risks associated with ICSI are:
- Certain genetic and developmental defects may be due to underlying issues that require ICSI rather than the technique itself.
- Boys conceived using ICSI may inherit a father’s infertility, and the initial findings of boys conceived with ICSI support this. ICSI offspring have half the sperm count, motility and concentration of typically conceived young men.
- There’s a higher risk of miscarriage, probably as the technique uses sperm that wouldn’t otherwise have been able to fertilise an egg.
- Low sperm counts could be passed to male children, which makes genetic testing before choosing ICSI for cystic fibrosis genes and other chromosome abnormalities a consideration.
- Discussing the full implications of testing with the embryologist or a specialist counsellor is recommended before testing. We also recommend that prospective fathers take steps to optimise their health and fertility at least three months before they consider having ICSI to help their fertility and their children’s health.
