ICSI (Intracytoplasmic Sperm Injection)

The Evolution of Male Infertility Treatment

Before the 1990s, men with very low sperm counts (less than 5 million per ml) or poor sperm quality had almost no chance of fathering a child. This all changed with the groundbreaking development of Intracytoplasmic Sperm Injection (ICSI) in Brussels, Belgium, in 1992. Since then, ICSI has enabled countless patients to achieve biological fatherhood. Our own ICSI program, started in 1995–96, has successfully completed over 800 cycles with a success rate of 30-40%, a figure comparable to the best fertility clinics worldwide.

What is ICSI?

ICSI is a specialized fertilization technique that is different from traditional IVF. In standard IVF, hundreds of thousands of sperm are placed with an egg in a dish, and fertilization is left to occur on its own. In ICSI, a single, live sperm is selected and directly injected into the center of a mature egg. This precise, “micro-fertilization” process is performed with the help of a sophisticated machine called a micromanipulator.

The ICSI Procedure: A Step-by-Step Guide

The ICSI process follows a similar timeline to a standard IVF cycle, but with a critical difference in the laboratory.

Ovarian Stimulation: Medication is used to stimulate the ovaries to produce multiple eggs. This is closely monitored with regular ultrasounds and blood tests.
Egg Retrieval: Once the eggs are mature, they are retrieved in a quick procedure under light anesthesia, guided by an ultrasound.
Sperm Collection: Sperm is collected and processed in the lab. For men with azoospermia (no sperm in the semen), sperm can be retrieved directly from the testis using procedures such as PESA, MESA, or TESE.
Micromanipulation: In the lab, a single, healthy sperm is carefully selected. An embryologist uses a micromanipulator to hold the egg and, with a tiny needle, injects the chosen sperm directly into the egg.
Embryo Development & Transfer: The fertilized eggs (now called embryos) are placed in an incubator for 2 to 5 days to allow for development. The highest-quality embryos are then transferred back into the uterus.

When is ICSI Recommended?

ICSI is often the recommended course of action for specific fertility issues, including:

Male Factor Infertility: Very low sperm count, poor sperm motility, or high levels of sperm antibodies.
Failed Fertilization: Previous IVF cycles with a low fertilization rate (below 20%).
Sperm Retrieval: When sperm is retrieved directly from the testis (TESA/PESA).
Ejaculation Issues: Problems with ejaculation due to spinal cord injuries or diabetes.

While some clinics now advocate for routine ICSI for all patients, we believe in a more conservative approach. If a patient’s sperm count is sufficient for standard IVF, we do not perform ICSI to minimize unnecessary handling of the gametes. However, for those in a “gray zone,” we may use a combination approach, fertilizing half the eggs with IVF and the other half with ICSI.

Our success rates remain consistently high, showing that our targeted approach is effective for both azoospermia and non-azoospermia patients.