The Life Plus Hospital

Pronounced ick-see IVF, ICSI stands for intracytoplasmic sperm injection. During regular IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg on its own. With ICSI-IVF, the embryologist takes a single sperm and injects it directly into an egg.

Some fertility clinics recommend ICSI for every IVF cycle. Others reserve the treatment for those with severe male infertility or another medically indicated reason.¹ There are good arguments against the routine use of ICSI. (The risks of ICSI-IVF are below.)

With that said, ICSI-IVF has enabled many infertile couples to get pregnant when, without it, they would not have been able to conceive using their own eggs and sperm.

 15 Infertility, IVF, and Fertility Treatment Myths

Why Is ICSI-IVF Done? 

ICSI-IVF is typically used in cases of severe male infertility, including:²

• Very low sperm count (also known as oligospermia)
• Abnormally shaped sperm (also known as teratozoospermia)
• Poor sperm movement (also known as asthenozoospermia)

If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction or TESE. Sperm retrieved through TESE require the use of ICSI. ICSI is also used in cases of retrograde ejaculation if the sperm are retrieved from the man’s urine.

Severe male infertility isn’t the only reason ICSI-IVF is used. Other evidence-based reasons for ICSI include:²

• Previous IVF cycle had few or no fertilized eggs: Sometimes, a good number of eggs are retrieved, and sperm counts look healthy, but no eggs get fertilized. In this case, during the next IVF cycle, ICSI may be tried.
• Frozen sperm are being used: If the thawed sperm don’t appear especially active, ICSI-IVF may be recommended.
• Frozen oocytes are being used: Vitrification of eggs can sometimes cause the hardening of the egg’s shell. This may complicate fertilization, and IVF with ICSI may help overcome this hurdle.
• PGD is being done: PGD (preimplantation genetic diagnosis) is an IVF technology that allows for the genetic screening of embryos. There is concern that regular fertilization techniques may cause sperm cells (who have not fertilized the egg) to “hang around” the embryo, and that this may interfere with accurate PGD results.
• IVM (in vitro maturation) is being used: IVM is an IVF technology where eggs are retrieved from the ovaries before they completely mature. They go through the final stages of maturation in the lab. Some research has found that IVM eggs may not become fertilized by sperm cells at rates comparable to traditional IVF. More research is needed, but it may be that IVM with ICSI is a good option.

Are there differences in embryo quality or pregnancy rates between ICSI and non-ICSI embryos?

There appears to be no difference in the overall embryo quality achieved with ICSI embryos when compared to non-ICSI embryos. Similarly, no difference in pregnancy rates has been shown between ICSI embryos and non-ICSI embryos. Although unproven, there is a belief among many infertility specialists that ICSI may increase embryo yield from a given number of eggs recovered, which has contributed to the increase in ICSI procedures.

Are there any other specific situations where ICSI might be recommended?

ICSI may be recommended when there is a reason to suspect that achieving fertilization may be difficult. ICSI is most often used with couples who are dealing with male infertility factors. Male infertility factors can include any of the following: low sperm counts, poor motility or movement of the sperm, poor sperm quality, sperm that lack the ability to penetrate an egg or azoospermia. Azoospermia is a condition where there is no sperm in the male’s ejaculation. There are two types of azoospermia: obstructive and non-obstructive. Obstructive azoospermia may be caused by any of the following:

• Previous vasectomy
• Congenital absence of the vas
• Scarring from prior infections

Non-obstructive azoospermia occurs when a defective testicle is not producing sperm. In the case of azoospermia, the probability of obtaining usable sperm is low, and the possibility of using donor sperm may be considered.

Success Rate

The ICSI procedure fertilizes 50 to 80 percent of eggs. You might assume all eggs get fertilized with ICSI-IVF, but they don’t. Fertilization isn’t guaranteed even when a sperm is injected into the egg.

Remember that fertilization rates don’t tell you the clinical pregnancy or live birth rates. Once fertilization happens, the success rate for a couple using ICSI with IVF is the same as a couple using regular IVF treatment.²

Price ICSI

How Much Does ICSI cost?

All procedures are similar to IVF except the oocytes are processed and manually fertilized with sperm using sophisticated technology and precision equipment.

• Single cycle Plan (Self): INR 70,000+ ICSI Charges INR 20,000 = 90,000

Inclusions:

Procedural charges (Oocyte aspiration, Embryology, Embryo Transfer)

• Semen Processing Charges
• Media and Lab Consumable Charges
• Consultations and Counseling
• Operation Theatre Charges
• Anesthetist Charges
• Nursing Services charges

Exclusions:

• Follicular Scans
• Medicines and injections
• Blood tests