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ICSI
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ICSI stands for intracytoplasmic sperm injection and it involves injecting one sperm into the middle of an egg. ICSI is always done as an additional option with an IVF cycle. At Advanced Fertility Care, ICSI happens in our state of the art embryology laboratory. Under the microscope, our embryologist isolates a single sperm and puts it into a specially designed needle. The needle with the single sperm is then carefully inserted past the outer shell of the egg, past the egg membrane and into the inner part of the egg called the cytoplasm.
Not all embryologists are equally skilled at ICSI. At Advanced Fertility Care, our embryologist obtains over an 80% fertilization rate of the eggs after ICSI. This is far above the normal average of 65%. A fertilization rate is different from a pregnancy success rate. A fertilization rate is the percentage of eggs that are injected with a sperm using ICSI that fertilize and begin to grow into an embryo.
Will I Need ICSI With My IVF Cycle?
Not all patients undergoing an IVF treatment need ICSI. ICSI is used to overcome male factor infertility, and it provides an alternative to couples who previously had to turn to donor sperm. ICSI allows couples with very low sperm counts or poor quality sperm to achieve fertilization and pregnancy rates equal to traditional IVF. The use of this specialized insemination technique represents a major advance in reproductive medicine and benefits couples with male factor infertility as well as couples where the female has abnormal egg morphology and previous IVF history of poor fertilization.
The American Society of Reproductive Medicine (ASRM) Indicates ICSI For:
- Very low number of motile sperm
- Severe teratozoospermia (abnormally shaped sperm)
- Problems with sperm binding and penetrating the egg
- Antisperm antibodies thought to be the cause of infertility
- Prior or repeated fertilization failure with standard IVF methods
- Frozen sperm limited in number and quality
- Obstruction of the male reproductive tract that is not able to be repaired. Sperm can be surgically removed in a procedure called a TESA (testicular sperm aspiration) and IVF is then done with ICSI.
Fertility clinics in the Phoenix Area vary a lot when it comes to ICSI. Many clinics do ICSI on all patients undergoing IVF, regardless of their medical history. At Advanced Fertility Care, we believe that ICSI should only be performed when it is medically indicated, which represents ~40% of our IVF patients. By individualizing our treatment plans to patients’ actual needs, we save our patients significant amounts of money while still providing the top success rates. In addition, much of the data that describes increased risks of congenital birth defects associated with IVF have attributed these very small increases to the ICSI procedure rather than to the IVF process itself. Therefore, limiting the use of ICSI to only those couples who would benefit seems to be the most prudent course to take.
At Advanced Fertility Care we are currently recommending in vitro fertilization (IVF) with ICSI for:
- All couples with severe male factor infertility that do not want donor sperm insemination.
- All couples with infertility with:
- Sperm concentrations of less than 15-20 million per milliliter
- Sperm motility less than 50%
- Very poor sperm morphology ≤ 4% normal shaped sperm by Kruger Morphology
- All couples having IVF who have had a previous cycle with no fertilization - or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
- All couples having IVF who have a very low yield of eggs at the egg retrieval - our current cutoff is 5-6 (or less) eggs. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (just mixing eggs and sperm together).
- All cycles utilizing frozen donor sperm from a sperm cryobank
IVF Success Rates With ICSI
ICSI success rates vary according to the specifics of the individual case, the ICSI technique used, the skill of the individual performing the procedure, the overall quality of the laboratory, the quality of the eggs, and the embryo transfer skills of the infertility specialist physician performing the procedure.
At Advanced Fertility Care, our IVF success rates with ICSI are the same as our IVF success rates without ICSI. Dr. Zoneraich believes that ICSI is a wonderful tool for patients that have the medical necessity for the procedure. To see our full report on our success rates, please take a look at our current IVF success rates.