ICSI - Intra Cytoplasmic Sperm Injection

At times an IVF procedure might be combined with an ICSI procedure. Hence if your doctor recommends this procedure it helps to have a clear understanding of why is this procedure required and how is it conducted.

Why do I have to do it?

The reason why your doctor will suggest you to go in for an ICSI procedure is related to fertilization. For pregnancy to occur, fertilization of the egg by a sperm is a pre requisite. In case this process is hampered due to any reason then pregnancy cannot happen. This fertilization process can be hampered by any of the following two reasons's relating to male infertility conditions:

  • The sperm cannot reach the egg at all.
  • Sperm can reach the egg but is unable to fertilize it.

Causes for the aforementioned situation:

ICSI procedure is generally recommended when the male partner faces any of the under mentioned infertility conditions:

  • Very Low or Zero Sperm count.
  • Poor mobility of the sperm. This can be due to abnormal shape of poor quality sperms.
  • Ejaculation of the sperms is affected, either due to blockage of the tube that carries it to ejaculation or due to back injury. In both these cases, the sperm production is not affected; however their ejaculation is blocked, which makes them unavailable for fertilization.
  • Problem with erection or ejaculation. In case these problems are irreversible, then a doctor might recommend ICSI. For psychological of infection based issues, 1st line of treatment is to treat the cause. In cases of back injury, diabetes, or certain other condition which hamper the erection or ejaculation irreversibly, then ICSI is recommended.

ICSI may also be recommended if during an IVF procedure, there are issue with the egg namely:

  • Enough Eggs could not be retrieved from the ovary. This makes every egg precious, and an ICSI procedure will help improve chances of successful pregnancy.
  • Eggs retrieved for IVF are not being fertilized successfully. In this case the window for the egg to be fertilized is quite short of 12-24 hours within its retrieval. In case this window is lost, another complete cycle of egg retrieval needs to conduct. In such cases, your doctor might recommend to go in for an ICSI procedure to ensure fertilization of the eggs.


The procedure for ICSI is same as that for IVF. The egg retrieval procedure is conducted similarly. Medication is followed by monitoring, which is followed by laparoscopic surgery for retrieval of the egg.

The sperm retrieval procedure might be same (retrieved by ejaculation) of different, based on the case of the patient.

  • Case 1: In case the sperms are not available in ejaculation, then the doctor might go in for a minor laparoscopic surgery of the male partner. This is done under local anaesthesia, and the sperms are retrieved either from your partner's testicals, or epidermis.
  • Case 2: After the aforementioned procedure is conducted and still the doctor feel that enough quantity of sperm have not been retrieved. Then in such cases the doctor will take a biopsy of the testicular tissue. This process is known as Testicular Sperm Extraction of (TESE).

These sperm retrieval procedure might be conducted before the egg retrieval to ensure that the sperms are available at the right time. The sperms collected before are frozen and stored for using them at the time of fertilization procedure.

Once both the egg and the sperm are in place, the doctors will then isolate one sperm, and inject it into 1 of the retrieved eggs.

After this the same procedure as IVF is followed again. The eggs are monitored and then transfer into the uterus. Following which the patient is monitored for early signs of pregnancy.


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