When is ICSI used?

ICSI is recommended in case of severe male factor infertility when the couple doesn’t want to use donor sperm. Yet, some clinics use it much more often for reasons other than male factor infertility.
ICSI can be chosen in the following cases:

• sperm count is less than 20 million per milliliter
• poor motility of the sperm (lower than 35%)
• a very low fertilization rate or fertilization failure during previous IVF
• anti-sperm antibodies
• sperm needs to be retrieved surgically (after a vasectomy or injury, for instance)
• problems with erection or ejaculation
• previously frozen eggs or sperm are being used
• the sperm has trouble attaching to the egg


Procedure

For the patient, all the steps in ICSI are the same as in standard IVF.

1. Both partners fill in consent forms and have blood tests.

2. The woman takes drugs (reproductive hormones) to encourage the development of the eggs in the ovaries. Ultrasounds are done to ensure the drugs work well. In many cases, ultrasounds are supplemented by blood tests.

3. The eggs are picked up from the woman’s ovaries with a small needle in the same way as in IVF.

4. If possible, a new sample of sperm is collected the same day. Sometimes, surgical sperm aspiration is required. If the sperm is stored in frozen storage, it is thawed. In case of zero sperm count, donor sperm may be considered.

5. Eggs are fertilized at the laboratory. An embryologist selects a sperm and places it into an egg with a fine needle.

6. The eggs are kept in an incubator at the laboratory for a couple of days. Ideally, the eggs develop into embryos.

7. Not more than 3 embryos are returned to the womb. If a multiple pregnancy is not desirable, your doctor will probably recommend a single embryo transfer.


Risks

There is evidence that the risk of birth defects may be increased in the case of IVF, including ICSI. A woman that gets pregnant naturally has a 1.5%-3% chance of having a baby with a major birth defect. For ICSI or IVF, the chance is slightly higher. So far, researchers have come to contradictory results, so accurate figures aren’t available.

The Practice Committee of the American Society of Reproductive Medicine states that ICSI may suggest higher chances of certain genetic abnormalities, yet it’s not known whether that’s because of the procedure itself or because parents have these abnormalities. For instance, a boy conceived with ICSI may inherit the infertility issues from his father.


Cost

The standard cost includes the following:

• blood tests before and during the treatment
• ultrasound scans
• medical counseling
• nursing care

If a couple needs additional procedures, like frozen embryo transfer, this affects the cost.

While ICSI doesn’t take long, it is a meticulous procedure that requires expertise. Make sure you get it done at a reputable medical clinic.