ICSI is an acronym for intracytoplasmic sperm injection - which is a long, fancy way of saying "inject sperm into the middle of the egg". ICSI is a very effective method to get fertilization of eggs in the IVF lab after they have been retrieved from the female partner. IVF with ICSI involves the use of specialized   micromanipulation tools and equipment   and   inverted microscopes   that enable embryologists to select and then pick up individual sperms in a tiny specially designed hollow ICSI needle. Then the needle is carefully advanced through the outer shell of the egg and egg membrane and the sperm is then injected into the inner part (cytoplasm) of the egg. This will usually result in normal fertilization in approximately 70-85% of eggs injected with viable sperm. First, the woman must be   stimulated with medications   and have an   egg retrieval procedure   so that we can obtain several eggs in order to attempt in vitro fertilization and ICSI.

Who should be treated with intracytoplasmic sperm injection?

There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not. Some clinics use it only for severe male factor infertility, and some use it on every case. The large majority of IVF clinics are somewhere in the middle of these 2 extremes. Our thinking has changed over time - we are now doing more ICSI (as a percentage of total cases) than in the past. Certainly, as we learn more about ways that we can help couples conceive, our thinking in this area will continue to evolve. Having said that, we are currently recommending   in vitro fertilization   (IVF) with ICSI for:

1. All couples with severe   male factor infertility   that do not want donor sperm insemination.
2. All couples with infertility with:
• Sperm concentrations of less than 15-20 million per milliliter
• Sperm motility less than 35%
• Very poor sperm morphology (subjective - specific cutoff value is not appropriate)
3. All couples having IVF who have had a previous cycle with no fertilization - or a low rate of fertilization (low percentage of mature eggs that are normally fertilized).
4. All couples having IVF who have a very low yield of eggs at the egg retrieval - our current cutoff is 5-6 (or less) eggs. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (just mixing eggs and sperm together).