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What is ICSI?
Intracytoplasmic Sperm Injection (ICSI) is a technique where a single sperm is given a helping hand to ‘enter’ the egg.
Since it only takes one single sperm to fertilise the egg, the embryologist catches a single sperm and injects it directly into the centre of the egg. This method is far more successful when there is male infertility problems.
ICSI sounds pretty simple but is one of the most technically challenging roles for an embryologist.
Who can use ICSI?
ICSI can be an option for patients who have:
- an abnormally low sperm count or poor motility
- a high percentage of abnormal sperm or few healthy sperm
- sperm obtained via testicular biopsy or micro TESE
- previously low fertilization rates with standard IVF
- undertaking Preimplantation Genetic Testing (PGT)
It is important to note that there is growing evidence that IVF success rates are actually better when standard insemination techniques are used instead of ICSI in couples who don’t fit the above categories.
ICSI can be used with fresh or frozen/thawed sperm. Our scientists will choose the best sperm from the sample, based on it being a normal shape, size and motility (movement).
Monash IVF tip: The treatment process is exactly the same as a standard IVF cycle; the only difference is the fertilisation technique the scientists use in the lab on the day your eggs are collected.
Sperm Selection Process
The healthiest sperm cells tend to have a certain shape and size, particularly an oval head and a long tail which they use to push themselves along as they swim. Infertile men often make fewer such sperm so that sperm selection for ICSI is important.
Next consideration is sperm motility – a sperm cell’s motility is its ability to move itself around and penetrate an egg. This depends on the length and size of its tail. Tails that are curly or doubled up aren’t as efficient when it comes to swimming.
Routinely in ICSI, a small amount of washed and prepared sperm is placed into thick viscous media that slows the sperm down so that they can be selected according to their shape, motility and trajectory.
The most “normal” looking and vigorous sperm are selected and then immobilized by squashing their tails with a glass injection needle. One these sperm are sucked into the needle tail-first ready to be injected.
Monash IVF tip: In some cases a Monash IVF embryologist will spend hours searching for the perfect sperm in a patient with a low sperm count or poor motility sperm to perform an ISCI. We stop at nothing to find the most perfect sperm.
How is an ICSI done?
The egg is placed in customized dishes under a microscope and moved using a leading micro-manipulator. A holding pipette secures the mature egg and then a thin, sharp glass micropipette, loaded with a single sperm, pushes first through the zona pellucida (outer egg casing) and then the oolemma (the cell membrane of the egg) to enter the centre (cytoplasm). The sperm is most delicately deposited into the centre of the egg.
In other words, we do all of the work for the sperm – no swimming or penetration of the egg involved. The only thing left for the sperm to do is make the ‘spark’ of fertilisation happen.
After the ICSI procedure, the egg is placed into the incubator and checked the following day for signs of fertilisation.
As ICSI is more invasive and requires more handling than standard IVF insemination techniques, there is a small chance (less than 2%) that the egg may be damaged during the procedure – resulting in a non-viable egg.
How is a Monash IVF ICSI unique?
The custom designed dishes we use for ICSI have resulted in greatly improve fertilisation rates for patients where ICSI is indicated.
Only our most experienced staff are trained in ICSI – embryologists with a degree of mastery and high technical proficiency.
All fertilised eggs are monitored daily for their growth and development.