The Intracytoplasmic Sperm Injection (ICSI) Procedure

Intracytoplasmic Sperm Injection (ICSI) is an assisted reproduction procedure that was first used in Belgium in 1992, and is still considered one of the major breakthroughs in treatment of male infertility.

In this article, we look at the ICSI procedure to find out what it entails, and also consider who ICSI is for and what success rate can be expected.


What is ICSI?

In short, Intracytoplasmic Sperm Injection (ICSI) is a procedure in which sperm are directly injected into the egg. The ICSI procedure forms part of In Vitro Fertilisation (IVF) treatment.

What does the ICSI process entail?

As part of In Vitro Fertilisation (IVF) treatment, ICSI treatment follows the same stages as IVF treatment. For decades, IVF treatment has safely been used to treat a variety of infertility challenges.

Essentially, IVF involves fertilising an egg with sperm outside of the body (in a glass tube – or “in vitro”) to form an embryo. The embryo is then placed in the uterus where it will hopefully implant and become a pregnancy.

IVF treatment, however, is not a single event, but a series of procedures that are completed over five stages to complete a treatment cycle that usually takes around three weeks.
There are five basic stages involved in the IVF procedure, as briefly described below.

Stage 1: Ovarian Stimulation and Monitoring – Standard IVF treatment begins with hormone therapy to stimulate the development of several follicles in the ovary.

Stage 2: Egg Retrieval – Using ultrasound technology, the follicles are punctured with a specialised needle to retrieve the eggs inside.

Stage 3: Fertilisation and Embryo Development – The eggs are then placed with the sperm in a petri dish (‘in vitro’ which literally means ‘in glass’) for fertilisation to create several embryos. It is in this stage that the ICSI procedure can be used instead of natural fertilisation.

Stage 4: Embryo Transfer – The embryos are then nurtured in an incubator for 3 to 5 days, where after one or two embryos are transferred through the vagina to the uterus where implantation will hopefully occur and result in pregnancy.

Stage 5: Luteal Phase Support – The Luteal phase is the two-week period between the embryo transfer and the pregnancy test.

As mentioned, the processes and stages are the same for ICSI as for conventional IVF. Ovarian stimulation (Stage 1) and egg retrieval (Stage 2) in IVF and ICSI are exactly the same. However, instead of natural fertilisation which is used in standard IVF treatment, the ICSI procedure can be used in Stage 3: Fertilisation and Embryo Development.

So, the ICSI procedure differs from the standard IVF procedure in the way the egg is fertilised during Stage 3. In Stage 3 of standard IVF treatment, around 50,000 and 100,000 sperm are placed in the same dish as a single egg to naturally fertilise the egg. Normal fertilisation is often confirmed the next morning if no abnormalities exist in the sperm. In other words, during standard IVF treatment, the sperm is allowed to penetrate the egg of its own accord. However, in cases of male factor infertility – such as significant abnormalities in the count, motility, and/or shape of the sperm – IVF can result in very poor fertilisation rates, often resulting in no fertilised eggs and thus no embryos for transfer.

In an ICSI cycle, however, qualified embryologists – using very fine tools in a process known as micromanipulation – inject each suitable mature egg with a single prepared sperm cell.

First, a semen sample is prepared at Medfem Fertility Clinic’s advanced onsite lab to collect as many healthy moving sperm as possible. The sperm are washed and prepared for fertilisation. Then, using a high magnification microscope, a single sperm in injected into the centre of a mature egg using a very fine glass needle many times thinner than a human hair.

Since ICSI involves the injection of only a single sperm into each egg, even the most severe of male factor abnormalities can be overcome. Because several steps in the early fertilisation process are bypassed and any potential problems the sperm may have in getting inside the egg is circumvented, the chance of fertilisation taking place is maximised.

The next step is again the same as the Embryo Transfer (Stage 4) of the IVF treatment process: the injected eggs are placed in an incubator and are checked the next day for signs of fertilisation. The embryos most likely to grow into a healthy baby are selected for transfer and are inserted into the uterus in the same way as during IVF.

For a more detailed explanation of each of the IVF treatment stages, click here

You can also watch a video of the ICSI treatment process being performed at Medfem Fertility Clinic here

Who is ICSI for?

The ICSI procedure is used primarily when men have poor semen characteristics. In cases of male factor infertility with significant abnormalities in the count, motility, and/or shape of the sperm, standard IVF may result in very poor fertilisation rates, often resulting in no fertilised eggs and thus no embryos for transfer.

ICSI is indicated for severe male infertility which includes a low sperm count; poor sperm morphology (abnormally-shaped sperm); poor sperm motility (slow-moving sperm); an obstruction which prevents sperm release (such as vasectomy); the presence of antisperm antibodies produced by the man’s body which may inhibit sperm function; or vasectomy reversals resulting in very low sperm counts or poor quality sperm production.

ICSI is usually offered to couples who have had poor or no fertilisation during standard IVF, or when fertilisation is thought to be less likely to occur with routine IVF. It offers an alternative to donor sperm.

What is the success rate of ICSI?

Since it was first used 30 years ago, ICSI has revolutionised the treatment of male infertility.

Because ICSI ensures only a few normal sperm are needed for conception, even men who were previously considered to be completely sterile now have a strong chance to have their own child.

ICSI has an excellent rate of fertilisation of around 70%. While ICSI does not absolutely guarantee fertilisation, the rate of complete failed fertilisation is very low and is most common in cases with limited egg supply.

To date, tens of thousands of children have been born around the world as the result of ICSI.

The first step in getting ICSI treatment

If you would like to know more about the ICSI procedure, the first step is simply to contact us at Medfem Fertility Clinic, one of the pioneers of IVF and ICSI treatments in South Africa.

Established in 1980, Medfem Fertility Clinic is registered as an Accredited IVF (In-Vitro Fertilization) Unit with the Southern African Society for Reproductive Medicine and Gynaecological Endoscopy (SASREG). Our team of accredited reproductive medicine specialists have over 100 years of collective experience and are nationally and internationally recognised as pioneers and innovators in the field of fertility treatment, including Dr Johan van Schouwenburg who was involved in the first successful IVF treatment carried out in South Africa in 1983. We perform an average of 1,100 IVF treatment cycles a year – and is proud to have played a role in bringing more than 16,000 babies into the world!

At Medfem we believe in helping you reach your family dream through:

* World-Class Fertility for Everyone – we believe in making world-class fertility treatments available for everyone
* A Positive Fertility Journey – It is our joy and commitment to give you a positive outcome to your fertility journey
* Delivered With Empathy & Caring – So you may have a fond memory, of a feeling of empathy, caring and being part of the Medfem family

Simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

We look forward to meeting you at Medfem Fertility Clinic!

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