Intracytoplasmic sperm injection (ICSI) is a very specialized technique performed by embryologists that involves injecting a single sperm into each egg retrieved from an IVF cycle. It was first introduced in the early 1990s to help fertilize eggs for couples with male factor infertility. Since the 1990s, the use of ICSI with IVF cycles has substantially increased. In fact, ICSI is now used in 80% of IVF cases performed in the United States, whether or not the male partner’s sperm is abnormal. Is this really necessary though?
The American Society of Reproductive Medicine (ASRM) published a committee opinion regarding the use of ICSI in 2012. It outlines when ICSI should be used and times when ICSI has no proven benefit. According to ASRM, ICSI is a safe and effective treatment for male factor infertility and when there was poor or failed fertilization in a prior IVF cycle. The use of ICSI may also be beneficial for patients with frozen eggs or eggs that were matured in vitro (outside of the body). Lastly, it may be used when the plan is to perform preimplantation genetic screening of embryos as it might prevent innaccurate results due to contamination from multiple sperm. According to ASRM, ICSI does not improve clinical outcomes for patients with unexplained infertility, low oocyte yield in an IVF cycle, and advanced maternal age. In addition, ASRM explicitly states there is no data to support the routine use of ICSI with all IVF cases.
So, why is ICSI being performed in so many IVF cases these days? There are probably several reasons. One may be to try to increase the chances of successful fertilization. I think every reproductive endocrinologist dreads seeing an IVF cycle where none of the eggs fertilize. So, many will use ICSI to “ensure” fertilization. According to ASRM though, more than 30 couples would have to undergo ICSI unnecessarily to prevent 1 failed fertilization case. ICSI can add $1000 – $3000 to the cost of an IVF cycle. This may be an additional charge that is unnecessary for the patient to endure.
If you are a patient undergoing IVF with ICSI and it’s not obviously for male semen issues, ask your doctor why you need it. ICSI is a great technology that can be beneficial to many patients.