Though the treatment has been around for more than two decades, intracytoplasmic sperm injection (ICSI) is still considered a breakthrough procedure for treating male infertility and other problems in which fertilizing an egg may be difficult. With ICSI, a single sperm is injected directly into an egg.

ICSI is used with in vitro fertilization (IVF) and is performed in more than 65 percent of IVF procedures. As a result of IVF with ICSI, more than 18,000 babies are born in the United States each year.

Is ICSI for me?

ICSI may be a good option if you have:

  • No sperm in your semen
  • A low sperm count
  • Slow sperm (low sperm motility)
  • Abnormally shaped sperm
  • Damaged or missing vas deferens (the tube that carries semen from the testes to the penis)
  • Had a vasectomy
  • Tried IVF but there were problems during the fertilization process

Your doctor might also suggest ICSI if you're using frozen eggs from a previous IVF cycle or if you've chosen to have your embryos undergo genetic testing before they're placed in the uterus.

What's the treatment for ICSI?

The timeline for ICSI treatment usually goes something like this:

  • Sperm collection. You provide a semen sample. An embryologist (a scientist who specializes in sperm, eggs, and embryos) obtains sperm from the sample. The doctor may time sperm collection with your partner's egg retrieval, or the doctor can collect the sperm in advance and freeze it until your partner's eggs are ready to be fertilized.
  • Microsurgery (if needed). When little or no sperm is in the sample, or you can't ejaculate, your doctor may perform microsurgery to remove sperm from the testicle or from the ducts that carry it. This procedure is usually done under local anesthesia, and the recovery isn't painful. You have to avoid strenuous activity for five to 10 days, but you can return to work in just a day or two.
  • Tissue sample (if needed). If microsurgery doesn't work, the doctor takes a tissue sample from inside your testicle, which could contain sperm. (If no sperm is found, your doctor may suggest that you consider using donor sperm to conceive a child.)
  • Gathering the eggs. When IVF treatment begins, your partner receives injections of a gonadotropin, a type of fertility drug to stimulate her ovaries to develop multiple mature eggs for fertilization. (She usually releases only one egg a month.) The doctor gives your partner an anesthetic and inserts an ultrasound probe through her vagina to look at the ovaries and identify follicles – the fluid-filled sacs where eggs develop and mature. Then, a thin needle is inserted through the vaginal wall to remove the eggs from the follicles. Eight to 15 eggs are usually retrieved.
  • Fertilization. Next, the embryologist injects the sperm, one at a time, directly into each of your partner's eggs. (By contrast, in traditional IVF, the sperm and egg are placed together in a glass dish and conception occurs when a sperm successfully enters the egg.) Three days later, each egg that was successfully fertilized becomes a ball of cells called an embryo.
  • Transferring the embryos. Depending on your partner's age and other factors, the doctor places between one and five embryos in her uterus by inserting a thin catheter through the cervix.
  • Growing a baby. If the treatment works, an embryo implants in your partner's uterine wall and grows into a baby. Extra embryos, if there are any, may be frozen and used in future IVF cycles. If more than one embryo was transferred, the chance of pregnancy is higher, but so is the risk of a multiple pregnancy – about 20 percent of babies born through IVF are twins, triplets, or more.
  • Testing for pregnancy. Your partner takes a pregnancy test after the embryos are placed in her uterus.

How long does ICSI take?

It takes about four to six weeks to complete one IVF with ICSI treatment.

You have to wait for your partner's ovaries to respond to the medication and for her eggs to mature. While taking the medication, your partner visits the doctor every two or three days for blood work and ultrasound appointments. On the day of the egg retrieval, you and your partner spend several hours at the doctor's office or clinic, having her eggs and your sperm collected.

Then three to five days later your partner comes back to have the embryos inserted inside her uterus. This visit usually lasts about one hour. Your partner takes the pregnancy test about two weeks later.

What's the success rate for ICSI?

Pregnancy and live birth rates of IVF with ICSI are similar to traditional IVF without ICSI. Based on recent national data, the percentage of IVF cycles resulting in a live birth (meaning at least one baby is born) is about:

  • 41 percent for women younger than 35
  • 31 percent for women age 35 to 37
  • 22 percent for women age 38 to 40
  • 12 percent for women age 41 to 42

What are the pros of ICSI?

  • Helps men with infertility. ICSI treats severe infertility in men that is otherwise untreatable. It helps men who produce no sperm or very small quantities of sperm become fathers.
  • Boosts the chance of fertilization. If you haven't had success with IVF due to problems fertilizing eggs, adding ICSI to your next treatment can improve the chance of fertilization because an embryologist handles the process in a lab.
  • May help when frozen eggs are used. ICSI is usually recommended whenever frozen eggs are used in IVF. It's unknown if ICSI improves the fertilization rate of frozen eggs, but since these eggs undergo certain changes during the freezing process, experts believe that ICSI may be a more effective way to fertilize them.

What are the cons of ICSI?

  • Costly and time-consuming. Fertilizing eggs for IVF requires expensive lab work and medications. Also, monitoring how your partner responds to fertility drugs requires a lot of her time, with frequent trips to the doctor's office for blood tests and ultrasounds. What's more, ICSI adds about $1,500 to the cost of IVF.
  • A genetic disorder can be passed on to a child. Men seeking ICSI can have genes that predispose them to fertility problems, such as a low sperm count or the lack of vas deferens. If this is the case for you, there's a chance that a male child could inherit the same fertility problem. This is just one reason to be screened for genetic disorders and to speak to a genetic counselor before having ICSI.  (Men who don't have vas deferens are advised to undergo genetic screening along with their female partner to find out if they carry mutations that make them more likely to have children with cystic fibrosis.)
  • Potential complications for a baby. While children conceived through ICSI seem to be as healthy overall as children conceived naturally, a few studies suggest that ICSI may slightly increase the rate of certain birth defects such as Angelman syndrome and hypospadias. However, more research is needed because there isn't enough data to draw firm conclusions.
  • Risk of multiples. Because more than one embryo may be placed in your partner's uterus during IVF treatment, your chance of having twins or more is about 20 percent. Some may consider this a blessing, but carrying multiples increases the risk of miscarriage and other complications such as preterm labor.
  • Other high-tech fertility treatment risks. Certain risks are involved whenever assisted reproductive technology (ART) is used. About 10 to 20 percent of women who take gonadotropins develop a mild form of ovarian hyperstimulation syndrome (OHSS), a condition marked by weight gain and bloating that happens when a woman's body responds too well to fertility drugs. (If this happens, your treatment may be cancelled.) IVF also boosts your partner's risk of having an ectopic pregnancy as well as her risk of delivering a premature or low-birth weight baby, but experts aren't sure whether that's because of the treatments or the factors causing the fertility problems.

How much does ICSI cost?

In the United States, the average cost for one IVF treatment is $12,400. This amount varies, depending on how much medicine you need, where you live, and whether your state mandates insurance coverage for infertility. ICSI adds about $1,500 to the tab. If your insurance policy doesn't cover IVF with ICSI, you'll probably have to pay the entire cost up front.

Learn more about handling the cost of fertility treatment.