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Fertility 101: ICSI - how it works

Fertility 101: ICSI - how it works

What is ICSI?

Intracytoplasmic Sperm Injection (or ICSI, as it’s more memorably known), is a technique used during IVF – most commonly in couples experiencing male fertility problems.

In a standard IVF round, all the sperm in a sperm sample (around 50,000 of them!) will be put together with the egg and left to fertilise.

With ICSI, a single sperm is selected. 

Using a tiny needle, the sperm is injected directly into the egg in a laboratory dish.  This is to increase the chances of fertilisation between sperm and egg where the sperm may find it difficult to break through on its own – for example if the egg’s outer casing is too thick or the sperm is unable to swim well.

As with standard IVF, once fertilisation has taken place, the embryo is left in the laboratory to grow for between one and five days, before it is then transferred to the woman’s uterus.

Is ICSI for me? 

The majority of couples use ICSI during IVF to combat sperm-related issues, as it’s the most successful option for male infertility.

For example, if you or your partner have:

  • A very low sperm count
  • Abnormally shaped sperm
  • Sperm that don’t swim well
  • A blockage the prevents sperm being ejaculated normally (either through illness, injury or genetic issue) or you’ve had a vasectomy
  • Had unsuccessful IVF treatments previously and none, or very few of the eggs fertilised
  • Unexplained infertility, i.e. the majority of fertility markers have tested within normal ranges for you and your partner but you've been unable to fall pregnant naturally

What’s the process?

The process is exactly the same as with a standard IVF round (go to our What’s the Process section of IVF Fertility 101).

However, in ICSI, the embryologist will inject a single sperm into the egg, rather than leaving the sperm and egg to fertilise on their own.

How much does it cost?

ICSI costs are between £500-£1,000 per treatment cycle and are applied on top of your standard IVF treatment costs (which are usually £4,000-£10,000 depending on drugs and test required). 

Will it work?

ICSI results look impressive, resulting in the successful fertilisation of the egg with the injected sperm in up to 90% of couples, and the overall success rates for IVF with ICSI versus IVF without are about the same (go to our Fertility 101 Will it work? section).  So if your doctor has isolated male factor issues as the key cause of your inability to get pregnant then it’s a great option to try.

Do remember though that as with all fertility treatments, egg quality is key – and declines with age – so in spite of the high fertilisation rates there’s no guarantee that the embryo will continue to develop normally and some embryos may stop growing. 

And if your treatment cycle isn’t successful, you might want to wait a few months after treatment to give yourself a bit of space and time to recover before trying again, provided your doctor thinks ICSI is still the best option for you.

Alternatively, you can explore the many other options to start a family, including using donor sperm, donor embryos, or adoption.

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