Are You Doing ICSI? Here's What You Need To Know


4 min read

Once your eggs are retrieved and whisked off to the embryology lab, that’s when the fertilization process begins. In traditional IVF, the sperm sample is combined with the eggs and the sperm are allowed to do the fertilizing on their own the way they would within the body. In some cases, where the sperm need a little help to get the job done, your doctor may suggest a procedure known as ICSI, also known as intracytoplasmic sperm injection. 

Conventional Insemination (left) compared to ICSI (right)

What Is ICSI and Who Is It For?

Intracytoplasmic sperm injection sounds intimidating, but it’s not as complicated as it seems. ICSI involves the embryologist sorting through a sperm sample and selecting the best quality sperm and injecting one of these sperm into each egg after the egg retrieval. 

ICSI provides huge benefits to male-factor infertility patients who have very low quantity or quality of sperm and therefore gives these patients, who otherwise would not be able to conceive, a chance at having genetically-related offspring. When there are very few sperm to work with in a sperm sample, the concern is that these sperm may not naturally make it to the egg in time to fertilize it. Similarly, in cases where the sperm quality is not optimal, ICSI is used because many times sperm that do not exhibit a normal shape cannot swim well and likely won’t be able to fertilize the eggs on their own.

Additionally, ICSI may be recommended for patients who have had total fertilization failure in previous cycles. This means that in past treatment cycles no fertilization took place when conventional insemination techniques were used. 

ICSI removes the responsibility of fertilization from the sperm and allows the embryology team to take over, ensuring each egg gets the chance to be fertilized. 

ICSI has been shown to increase fertilization rates for those with some forms of male-factor infertility. However, ICSI has not been confirmed to show benefits to those with other types of infertility, which is why ICSI isn’t widely used across all IVF cycles. Talk to your doctor if you want to know if ICSI may be right for you. 

What Happens During ICSI?

During ICSI, the embryologist holds each egg still, one at a time, using gentle suction through a glass pipette. Then they draw up one sperm into a tiny needle. Next, they puncture through the outer coating of the egg and inject the singular sperm into the cytoplasm of the egg. Finally, the needle is removed and the rest of the fertilization process is allowed to happen naturally.

Risks of ICSI

ICSI is generally low risk. The main risk associated with ICSI is damage to the egg when inserting the needle to complete the ICSI procedure. There is also the risk that fertilization does not occur even though ICSI was done. 

Currently, the research to determine if ICSI results in a higher risk of birth defects is inconclusive. According to the CDC, “Findings from some but not all studies suggest that ICSI is associated with an increased risk for chromosomal abnormalities, autism, intellectual disabilities, and birth defects compared with conventional IVF. These increased risks may also be due to the effects of subfertility.”

Your doctor can discuss the pros and cons of ICSI for your specific case to help you decide if ICSI’s benefits outweigh its risks.

What Does ICSI Cost?

ICSI does add additional fees to an already expensive IVF process. According to FertilityIQ, ICSI can add between $800-$2500 to your cycle costs depending on the city where you  receive treatment. 

That being said, to many couples facing male-factor infertility, the fee is worth it for the possibility to conceive genetically-related offspring.

Talk with your doctor about ICSI to determine if it is something that may increase your chances of success.