Intracytoplasmic Sperm Injection
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Intracytoplasmic Sperm Injection
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Literature review current through: Jan 2021. | This topic last updated: Aug 06, 2019.
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ICSI was first applied to human gametes in 1988 [ 1 ]; it was first used in cases of fertilization failure after standard IVF or when few sperm cells were available. The first pregnancies were reported in Belgium in 1992 [ 2 ]. This technique has consistently demonstrated higher fertilization rates than prior micromanipulation techniques and produced more embryos with higher implantation rates [ 2-5 ]. The capacity of ICSI to permit almost any type of spermatozoa to fertilize oocytes has made it the most successful treatment for male factor infertility. In 2016, IVF with ICSI comprised 66 percent of initiated assisted reproductive technology (ART) procedures in the United States [ 6 ]. The use of ICSI in the United States has increased dramatically since 1995, without a proportionate increase in diagnosis of male factor infertility [ 7 ]. The use of ICSI for male factor infertility increased from 84 percent in 2003 to 93 percent in 2012 [ 8,9 ]. Worldwide, there is geographic variation in the use of ICSI with IVF [ 10 ].
This topic discusses the indications, techniques, and outcomes for ICSI. Other treatments for male infertility are discussed elsewhere. (See "Treatments for male infertility" .)
The most common genetic factors associated with male infertility are cystic fibrosis gene mutations (associated with congenital absence of the vas deferens), structural chromosomal abnormalities (eg, aneuploidy, inversion, translocation) associated with impaired testicular function, and Y chromosome microdeletions (associated with impaired spermatogenesis). Cystic fibrosis is associated with a mutation of the cystic fibrosis transmembrane conductance regulator gene. Men who carry this gene may not have the classic clinical manifestations of cystic fibrosis. (See "Causes of male infertility", section on 'Sperm transport disorders' .)
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What is intracytoplasmic sperm injection (ICSI)?
ICSI | Intracytoplasmic Sperm Injection | Advanced Fertility Treatment
Intracytoplasmic Sperm Injection (ICSI) - human-fertility.com
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Before a man’s sperm can fertilize a woman’s egg, the head of the sperm must attach to the outside of the egg. Once attached, the sperm pushes through the outer layer to the inside of the egg (cytoplasm), where fertilization takes place.
Sometimes the sperm cannot penetrate the outer layer, for a variety of reasons. The egg’s outer layer may be thick or hard to penetrate or the sperm may be unable to swim. In these cases, a procedure called intracytoplasmic sperm injection (ICSI) can be done along with in vitro fertilization (IVF) to help fertilize the egg. During ICSI, a single sperm is injected directly into the cytoplasm the egg.
There are two ways that an egg may be fertilized by IVF: traditional and ICSI. In traditional IVF, 50,000 or more swimming sperm are placed next to the egg in a laboratory dish. Fertilization occurs when one of the sperm enters into the cytoplasm of the egg. In the ICSI process, a tiny needle, called a micropipette, is used to inject a single sperm into the center of the egg. With either traditional IVF or ICSI, once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 1 to 5 days before it is transferred to the woman’s uterus (womb).
ICSI helps to overcome fertility problems, such as:
ICSI fertilizes 50% to 80% of eggs. But the following problems may occur during or after the ICSI process:
Once fertilization takes place, a couple’s chance of giving birth to a single baby, twins, or triplets is the same if they have IVF with or without ICSI.
If a woman gets pregnant naturally, there is a 1.5% to 3% chance that the baby will have a major birth defect. The chance of birth defects associated with ICSI is similar to IVF, but slightly higher than in natural conception.
The slightly higher risk of birth defects may actually be due to the infertility and not the treatments used to overcome the infertility.
Certain conditions have been associated with the use of ICSI, such as Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, or sex chromosome abnormalities. They are thought to occur in far less than 1% of children conceived using this technique.
Some of the problems that cause infertility may be genetic. For example, male children conceived with the use of ICSI may have the same infertility issues as their fathers.
© 1996 - 2021 ASRM, American Society for Reproductive Medicine. All Rights Reserved.
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