ICSI - Intracytoplasmic Sperm Injection
Intracytoplasmic Sperm Injection (ICSI) is a technique where a single sperm is given a helping hand to ‘enter’ the egg. This method is especially successful in overcoming male infertility problems.
Keen to know more? Read on to discover more about the ICSI process, and whether or not it could be right for you.
For patients using ICSI, the treatment process is exactly the same as a standard IVF cycle. The only difference? The fertilisation technique the embryologists use in the lab on the day your eggs are collected.
How does ICSI work?
Since it only takes one single sperm to fertilise the egg, our highly experienced scientists known as Embryologists search and catch the ideal sperm and inject this single sperm directly into the centre of the egg.
Actually, ICSI is one of the most technically challenging procedures for an embryologist.
At Monash IVF, we’re 100% committed to increasing your chances of having a family. So only our most experienced scientists are trained in ICSI.
Who can use ICSI?
Wondering whether ICSI is right for you?
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 fertilisation rates with standard IVF
- undertaken Preimplantation Genetic Testing (PGT)
If you don’t fit one of the above categories, however, you’re probably better off using standard IVF rather than ICSI. There’s growing evidence to suggest that IVF success rates are actually higher when standard insemination techniques are used.
The takeaway? Think of ICSI as a viable Plan B.
The ICSI process
ICSI can be performed with either fresh sperm or thawed frozen sperm. Our expert scientists choose the ideal sperm from the sample. The ideal sperm is not too fat or too thin, with a tail that’s not too long or too short and is referred to as having normal morphology (shape/structure). Being able to identify morphologically normal sperm is a skill that our scientists develop over many years, with constant fine tuning, to select the ideal sperm for every egg. The ideal sperm will have not only the normal morphology but also good motility (movement).
The ICSI process
Step 1: Sperm selection
It’s a real skill to spot a morphologically normal ‘ideal’ sperm cells - they need to have a certain shape and size in many parts of the sperm cell. These sperm have an oval head and a long tail which they use to help them swim. Men with infertility issues often make fewer such sperm, which is why sperm selection for ICSI is so vitally important.
The next thing to consider is sperm motility or movement. Essentially, a sperm with good motility is able to move itself around and penetrate an egg. This movement depends on the length and size of the sperm’s tail. Tails that are curly or doubled up can’t swim as efficiently.
In order to select the best sperm for ICSI, the embryologist places a small amount of washed and prepared sperm into thick viscous media. This slows the sperm down, making it easier to observe and identify the ideal sperm based on their shape, motility and trajectory (direction).
Once our embryologists have selected the most morphologically normal and vigorous sperm, they immobilise them by striking their tails with a glass injection needle. True story!
They then aspirate (suck up) a single sperm into the needle tail-first, ready to be injected into the egg.
The ICSI process
Step 2: Injecting the sperm into the egg
First, our embryologist places the egg in a customised dish under a microscope, moving it using advanced micro-manipulators. Next, they search for the ideal sperm for injection and immobilise this sperm and position it in the injection pipette. Then, they use a holding pipette to secure the mature egg in place. Finally, a thin, sharp glass micropipette - loaded with a single sperm - pushes first through the zona pellucida (the outer egg casing) and then the oolemma (the cell membrane of the egg) to enter the egg’s centre (the cytoplasm). The embryologist deposits the sperm ever so delicately into the centre of the egg.
In other words, our scientists do all of the work for the sperm - there’s no swimming or penetration of the egg involved. The only thing left for the sperm to do is to fertilise the egg.
The ICSI process
Step 3: Fertilisation
After the ICSI procedure, we place the egg into our specialised culture incubators to assess for fertilisation ~17 hours later the next day, looking for signs or normal fertilisation, 2 pronuclear bodies known as ‘pronuclei’. These pronuclei are the genetic nucleus from the egg and sperm, so we need to see only two pronuclei, one from the egg and one from the sperm. If the egg does not present with 2 pronuclei, then the egg has not fertilised and will not produce an embryo.
Our embryologists will sometime spend hours searching for the perfect sperm for ICSI - especially in patients with a low sperm count or poor motility. We stop at nothing to find the perfect, most vigorous sperm.
If you think ICSI might be right for you, it’s a good idea to talk through the process with your fertility specialist. They’ll tailor a treatment plan to your individual circumstances to give you the very best chance of success.
 “The Vienna Consensus: Report of an Expert Meeting on the Development of Art Laboratory Performance Indicators.” Reproductive BioMedicine Online, vol. 35, no. 5, 2017, pp. 494–510, https://doi.org/10.1016/j.rbmo.2017.06.015.
Start your fertility journey
Wherever you are on your journey, one of our supportive nurse enquiry team can help you understand your options and take the next step. These conversations are free and informative.