Dr Komalas Women Clinic - Infertility-ICSI

Infertility - ICSI

Intracytoplasmic Sperm Injection (ICSI) is a kind of In Vitro Fertilisation (IVF) used to treat severe cases of male-factor infertility. ICSI is a technique that includes injecting a single sperm directly into a mature egg. Preimplantation genetic testing, or PGT testing, is another popular method. In fact, if you’re performing PGT testing, most clinics demand it. The idea behind this restriction is that during traditional insemination, the sperm attempting to fertilise an egg might tear the embryo’s lining, resulting in incorrect PGT findings.

What is ICSI?

The head of a man’s sperm must adhere to the exterior of the egg before it may fertilise a woman’s egg. Once connected, the sperm makes its way through the egg’s outer layer to the cytoplasm, where fertilisation occurs. There are several reasons for infertility, where sperm may be unable to enter the outer layer.

The sperm may be unable to swim, or the egg’s outer layer may be thick or difficult to penetrate. In certain situations, intracytoplasmic sperm injection (ICSI) can be used in conjunction with in vitro fertilisation (IVF) to aid in the fertilisation of the egg. A single sperm is injected directly into the cytoplasm of the egg during ICSI.

How is ICSI done?

IVF may be used to fertilise an egg in two ways: conventional and ICSI. 50,000 or more swimming sperm are put close to the egg in a laboratory dish in conventional IVF. When one of the sperm penetrates the cytoplasm of the egg, it fertilises the egg.

A small needle called a micropipette is used to inject a single sperm into the centre of the egg during the ICSI procedure. After fertilisation, the egg develops in a laboratory for 1 to 5 days before being transferred to the woman’s uterus via standard IVF or ICSI.

Steps for an ICSI procedure

Step 1: Retrieval

The man must generate a sperm sample by ejaculating into a cup, or the sperm must be surgically extracted. The sperm can be extracted using various methods. The sperm retrieval process may be conducted early in some circumstances, and it may be frozen. A tiny needle and ultrasound probe will be used to extract several eggs from the woman’s ovaries.

Step 2: Injection of Sperm into Egg

The semen sample is then cleansed, and a single sperm is extracted. With a very small hollow needle, it is then inserted into an egg. The sperm does not have to swim through the cervical fluid since it is injected immediately. It can take up to 24 hours for sperm to fertilise an egg and form an embryo.

Step 3: Monitoring the Embryo

The fertilised embryos are maintained in a laboratory for up to 6 days after fertilisation. During this stage, they are observed for signs of development and growth. Not all fertilised embryos will be transported to the mother’s uterus. As a result, this stage is critical for selecting the healthiest and most viable embryos.

Step 4: Transfer of Embryos

One or two embryos are chosen and transferred to the woman’s womb using an ultrasound-guided catheter once the embryo has reached a specific stage of development. This might happen two days after conception or five days later.

Why is ICSI done?

ICSI is performed for the following reasons: 

  • If the male partner produces too few sperms for artificial insemination
  • If your sperm does not move in the normal fashion
  • If your sperm has trouble attaching to the egg
  • If there is any blockage in the male reproductive tract
  • If eggs are not fertilised by traditional IVF
  • If in vitro matured eggs are being used
  • If previously frozen eggs are being used
  • If your sperm is abnormally shaped 
  • If your sperm has poor movement 
  • If the previous IVF cycle has not fertilised any eggs

What is ICSI-IVF?

ICSI is a procedure used in IVF. Because ICSI is performed in a lab, your IVF procedure will be similar to the one that does not include ICSI. You’ll be asked to take ovarian stimulating medications, like normal IVF, and your doctor will track your development with blood tests and ultrasounds. 

After you’ve generated enough healthy follicles, you’ll undergo an egg retrieval procedure, where eggs will be extracted from your ovaries using an ultrasound-guided needle.

What are the Risks of ICSI-IVF?

Some birth malformations, including Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, and sex chromosomal abnormalities, are more likely to develop during ICSI-IVF. They affect fewer than 1% of infants conceived with ICSI and IVF. There’s also a slightly higher chance that a male infant will have reproductive issues in the future. This is because male infertility may be handed down through generations.



When a man’s sperm fails to fertilise an egg despite IVF, a specific technique known as Intracytoplasmic Sperm Injection may be used. This increases the couple’s chances of becoming pregnant. Male infertility caused by low sperm count, low motility, azoospermia, erectile dysfunction, or infertility with no identified cause may be treated using this technique.

The female partner will need to take fertility medicine to boost egg production in the ovaries, similar to traditional IVF. During this period, the doctor will keep an eye on the eggs’ growth. When the egg is ready to be extracted, the ICSI technique is performed.

50 to 80 percent of eggs are fertilised with the ICSI technique. You might think ICSI-IVF fertilises all eggs. However, this is not the case. Even when sperm is put into the egg, fertilisation is not assured.

If a woman becomes pregnant naturally, her kid has a 1.5 to 3% risk of being born with severe birth problems. ICSI has a risk of birth abnormalities comparable to IVF. However, it is somewhat greater than spontaneous conception. The slightly increased risk of birth abnormalities may be related to infertility itself rather than the therapies employed to overcome it.

It is a slightly expensive procedure. The ICSI-IVF procedure costs more than the simple procedure.

  • Increased risk of miscarriage
  • Heart problems in affected infants that may require surgery
  • Increased risk of behavior or learning disabilities
  • Increased risk of infertility in your children during their adulthood

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