ICSI – Intracytoplasmic
Sperm Injection

ICSI is one of the most important advances in IVF in the last 20 years. Since its introduction in 1991 and 1992, it has revolutionized the treatment of male fertility.

During ICSI, an embryologist uses a needle to pick up just one single sperm under the microscope, and then injects that sperm directly into the center of a mature egg. This procedure helps overcome certain male fertility health challenges. At Monash IVF, ICSI is frequently utilized for patients undergoing in vitro fertilization (IVF).

When ICSI is considered?

ICSI, or Intracytoplasmic Sperm Injection, is considered in cases where there are issues with male fertility, such as low sperm count or poor sperm quality. It is also used when conventional in vitro fertilization (IVF) methods have not resulted in successful fertilization. ICSI involves injecting a single sperm directly into an egg to facilitate fertilization.

Addressing Sperm Health Challenges through ICSI

  • Sperm Health Disorders: When a patient experiences issues such as low sperm count, abnormal sperm shape and appearance, or low sperm motility (movement), they can benefit from utilizing ICSI.
  • Sperm Ability to Survive the Journey: During ejaculation in intercourse, only a limited number of sperm manage to reach the fallopian tubes. Within the fallopian tubes, sperm cells undergo both biochemical and functional changes to acquire the capability to fertilize the egg. Through ICSI, the embryologist directly introduces a single sperm into the egg, bypassing the need for the sperm to navigate the challenging journey.
  • Difficulty in Penetrating the Egg: In certain cases, the outer layer of the egg may be too thick and rigid for sperm to successfully penetrate during conventional fertilization. This challenge can be associated with issues such as sperm antibodies or conditions affecting the outer layer of the egg. ICSI proves effective in facilitating the placement of sperm inside the egg under such circumstances.
  • Low Fertilization Rates: Individuals who have experienced low fertilization rates with standard In Vitro Fertilization (IVF) may find improved success by opting for ICSI, thereby enhancing their chances of achieving pregnancy. Additionally, ICSI is the required procedure for couples utilizing sperm obtained through testicular biopsy or Microsurgical Testicular Sperm Extraction (micro-TESE).

ICSI is required for patients undergoing Preimplantation Genetic Testing (PGT) on their embryos.

  • In standard insemination, some sperm may not fertilize the egg and may adhere to the outer surface of the egg. This situation can lead to inaccurate results when conducting genetic testing on the embryo. Therefore, ICSI is mandatory when genetic testing is required.
  • However, due to its yield of a slightly higher fertilization rate, approximately 60–70%, some centers and couples opt for ICSI as the default method of fertilization for every couple seeking IVF treatment options.
  • When an egg is extracted from the ovary, it is enveloped by a dense cluster of cells known as cumulus cells. These cells create challenges in observing the egg under the microscope, making it difficult to ascertain the maturity of the egg for fertilization. In instances of poor fertilization, the issue may be attributed, in part, to the presence of numerous immature eggs rather than a problem with the sperm.
  • During ICSI, these cumulus cells are removed, enabling a more precise assessment of your eggs and ensuring a definitive determination of their readiness for fertilization.

What to expect from ICSI treatment?

Before an embryologist performs IVF with intracytoplasmic sperm injection, the doctor collects eggs from the female patient or the egg donor. The male patient also provides a semen sample.

For the patient, the ICSI procedure will be identical to the conventional IVF procedure, with the difference occurring only in the lab setting. The woman will receive daily injections for several weeks to obtain control over ovulation and stimulate superovulation (releasing multiple eggs to increase the chances of fertilization from a single procedure). You will also be regularly monitored by your specialist through blood work and ultrasounds.

Once you are ready for your egg retrieval, you will need to undergo a minor outpatient surgical procedure called follicular aspiration. Under sedation, the doctor will use an ultrasound to locate the eggs in your uterus, and then remove them through your cervix. Sperm from your partner or donor will then be collected and the ICSI procedure will be performed in a sterile lab setting under a microscope. Fertilized eggs will be placed in the uterus of the mother or surrogate for implantation. These procedures have a short recovery period, where you will be asked to avoid strenuous activity for 1-5 days. You will then return to the clinic for a pregnancy test after 14 days.

ICSI with Monash IVF Fertility Specialists in Singapore

ICSI is operator dependent, which means that the outcome of the ICSI depends on the experience and the training of the embryologist or the scientist who is performing the procedure. Only our most experienced staff are trained in ICSI – embryologists with a degree of mastery and high technical proficiency. We also use custom designed dishes which have resulted in improved fertilisation rates for patients where ICSI is indicated.

Start your fertility journey at Monash IVF, one of the top fertility clinics in Singapore. We have a wide range of reproductive services and treatments to support you. Check out our website to find out more about our services such as embryo transfers, sperm freezing and the cost of IUI in Singapore.