Intracytoplasmic Sperm Injection

Intracytoplasmic sperm injection (ICSI) is a method of artificial insemination. It involves injecting a single sperm directly into the cytoplasm (ooplasm) of an egg using a microcapillary device. The procedure is always combined with in vitro fertilization (IVF). The first ICSI baby was born in Brussels on January 14, 1992.

Indications (areas of application)

  • Failed fertilizations (failed in vitro fertilizations) for example because of male factor (sperm quality impairment), zona pellucida defect (defect of the gas skin, that is, the envelope of the egg), spermatozoa antibodies (antibodies against sperm), etc.
  • In the case of high-grade restriction of sperm quality (OAT III – oligo astheno teratozoospermia; cryptozoospermia – see the spermiogram).
  • Occlusive azoospermia (= absence of mature as well as immature sperm in the ejaculate) – in such cases, the spermatozoa (sperm) are obtained, for example, by MESA (microsurgical epididymal sperm aspiration) from the epididymis
  • Testicular azoospermia – for example, because of testicular atrophy, Sertoli-cell-only syndrome, etc. – in such cases, the spermatozoa are obtained, for example, by microsurgical measures from the testicle “TESE” (testicular sperm extraction)

Before treatment

An intracytoplasmic sperm injection must be preceded by an examination of the man by doctors with the additional title “andrology“. This includes a self, family, and couple history including a sexual history, a physical examination, and an ejaculate analysis (including a spermiogram). If indicated, this is supplemented by scrotal sonography and, if necessary, hormone diagnostics and cyto- or molecular genetic diagnostics. If sexually transmitted diseases (STDs) and other urogenital infections are present that could endanger the woman or child, these must be treated [Guidelines: Diagnosis and therapy before assisted reproductive medicine treatment (ART)].

The procedure

Intracytoplasmic sperm injection involves injecting a single sperm (sperm cell) directly into the cytoplasm (ooplasm) of an egg using a microcapillary device. The procedure is always combined with in vitro fertilization (IVF). In addition to the ICSI procedure, there is the so-called PICSI procedure (physiological intracytoplasmic sperm injection), in which the sperm required for the intracytoplasmic injection are selected according to biochemical rather than morphological criteria. Hyaluronic acid is used for selection. Hyaluronic acid is an important component of the zona pellucida (glass skin; protective covering around the oocyte). Mature spermatozoa bind to the zona pellucida via it. Hyaluronic acid selection lowers the proportion of sperm with DNA damage (genetic damage) or aneuploidy (occurrence of abnormal chromosome numbers in the nucleus). According to a study of 2,752 couples, when comparing ICSI versus PICSI, the rate of children born healthy and mature was the same, as was the proportion of preterm births, but significantly fewer pregnancies ended in preterm birth after PICSI than after ICSI (4% versus 7%).CONCLUSION: Because the live birth rate using PICSI is comparable to that of the ICSI procedure, current knowledge suggests that use of the procedure is not recommended.

Pregnancy Rates

  • The pregnancy rate in Germany in 2016 per embryo transfer was 33.8% after IVF and 31.8% after ICSI.
  • Prospects of success in having another child this way after birth of a first child with the help of assisted reproductive technology (ART; here, intracytoplasmic sperm injection (ICSI) and IVF) (note: in three quarters of women, surplus frozen embryos from the first time could be used) are as follows:
    • In 43.4% of cases, even the first cycle of treatment, including the transfer of frozen embryos, resulted in the birth of a child
    • After a maximum of three complete treatment cycles, the cumulative live birth rate was conservatively estimated at 60.1% and at best 81.4%.
    • Cumulative live birth rate after up to six cycles ranged from 50% to 88%.

Further notes

  • Results of a retrospective study of men diagnosed with cryptozoospermia (<1 million spermatozoa/mL) who underwent ICSI (ejaculated spermatozoa versus spermatozoa obtained by testicular sperm aspiration (TESA) or conventional testicular sperm extraction (TESE)):
    • Fertilization rate (fertilization rate): 59.6% vs. 60.6
    • Good quality embryos: 36.8% versus 46.1%.
    • Implantation rate: 30.7% versus 52.1
    • Pregnancy rate: 33.3% versus 53.6
    • Birth rate: 27.1% versus 44.6
  • Disadvantage of sperm collection by TESE/TESA: increased rate of complications due to:
    • Bleeding
    • Infections
    • Testicular atrophy
  • Children conceived with the help of intracytoplasmic sperm injection have an increased rate of malformation by about 57%. However, this is not attributed to the technique, but to the fact that this form of infertility is an expression of genetic predisposition.
  • Boys conceived with intracytoplasmic sperm injection apparently inherit the infertility of their fathers. This show results of spermiogram studies: Sperm density in the ejaculate (7.7 versus control group: 37.0 million/ml), total sperm count (31.9 versus 86.8 million) and motile sperm count (12.7 versus 38.6 million).
  • Men who have fertility treatment with the microinjection technique ICSI (intracytoplasmic sperm injection) have a significantly higher risk of prostate cancer (47% versus men in the control group).

Please note

The physical and mental health of men and women, as well as a healthy lifestyle are important prerequisites for successful fertility treatment. Before starting therapeutic measures, you should in any case – as far as possible – reduce your individual risk factors! Therefore, before starting any reproductive medical measure (e.g. IUI, IVF, etc.), have a health check and a nutritional analysis performed to optimize your personal fertility (fertility).