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. In doing so, it bypasses some of the male fertility health challenges. At Monash IVF, ICSI is often used for patient undergoing in vitro fertilisation.

When ICSI is considered?

There are a number of reasons why ICSI is preferred over standard insemination. First, if a man has low sperm counts, poor sperm movement, a high percentage of abnormal sperm, or a low percentage of healthy sperm, then successful fertilization using other methods is unlikely. ICSI also helps to bypass unforeseen problems with sperm that make difficult for them to fertilize an egg.

Addressing Sperm Health Challenges through ICSI

Sperm Health Disorders: When the patient faces issues related low sperm count, abnormal sperm shape and appearance, low sperm count, or low motility (movement), they can benefit from utilising ICSI.

Sperm Ability to Survive the Journey: When sperm is ejaculated during intercourse, only a few sperm can reach the fallopian tubes. In the fallopian tubes sperm cells undergo both biochemical and functional changes to gain the ability to fertilise the egg. With ICSI, the embryologist places a single sperm directly into the egg. The sperm avoids having to go through the challenge journey.

Unable to Penetrate the egg: Sometimes the outer layer of the egg is to thick and hard for sperm to breakthrough in normal fertilisation. This can be related to sperm antibodies or conditions of the outside layer of the egg. ICSI is effective in helping the sperm get place inside the egg.

Patients who have had previously low fertilization rates using standard IVF may benefit from using ICSI to increase their chances of pregnancy. ICSI is also the necessary procedure for couples using sperm obtained via testicular biopsy or Microsurgical Testicular Sperm Extraction (micro-TESE).

Finally, ICSI is needed for patients undergoing Preimplantation Genetic Testing (PGT) on their embryos. With standard insemination, there may be sperm that do not fertilize the egg that become stuck to the outside of the egg. This can cause an incorrect result when trying to do genetic testing of the embryo, so ICSI is mandatory when genetic testing is required.

However, because it results in a slightly higher fertilization rate, about 60–70%, some centers and some couples decide to do ICSI as a default method of fertilization for every couple seeking IVF treatment options. When an egg is removed from the ovary, it is surrounded by a dense group of cells called cumulus cells. These cells make it difficult to see the egg under the microscope, making it more difficult to determine whether the egg is mature enough for fertilization. When there is poor fertilization, it could be in part due to there being many immature eggs rather than a problem with the sperm.

When we do ICSI, these cumulus cells are stripped away, allowing us to more accurately evaluate your eggs and to know with certainty whether an egg is ready 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

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.

At Monash IVF, all fertilised eggs are monitored daily for their growth and development.