ICSI is a relatively new technique that revolutionizes the treatment of severe male factor infertility. With ICSI, an infertile male with very low sperm count or motility has a good chance to father a child. During ICSI, each of the retrieved eggs is placed in a dish, then the embryologist surgically inserts one healthy sperm into each egg. This is done by delicately perforating the membrane of the egg with a glass pipette containing the sperm. This requires extremely high level skills and experience. The next day it is possible to determine which eggs have been successfully fertilized. Since only one sperm is required to fertilize each egg, ICSI is useful for couples where the male patient has low sperm count or poor sperm morphology. ICSI may also be recommended for couples who have had low or no egg yield or poor fertilization success in the past, since there is greater control of fertilization.
Recent evidence indicates that most cases of severe male factor infertility are not due to hormone deficiency. As such, they will not respond to hormonal or medical treatment. Other treatments, including IVF and ET, are also not very effective for this condition.

Follow-up of children born from ICSI so far indicates that they have normal physical and mental development. Given the fact that many cases of severe male factor infertility are now known to be due to gene abnormality or micro-deletion,  it is theoretically possible that this genetic abnormality can be transmitted to the offspring. This implies that  when the male children become adults, they might also have the problems with severe male infertility.

ICSI is especially important for men with Azoospermia (the complete lack of semen on ejaculation). In such cases, we can also offer a procedure called testicular sperm extraction (TESE), where our doctor extracts small amounts of semen directly from the testes, which can then be used for ICSI. In a high percentage of cases, Azoospermic males can still achieve fatherhood.

We have been performing ICSI since 1997 and after hundreds of cycles have achieved success rates comparable to the best in the world. We generally recommend ICSI for all patients where there may be some doubt as to the viability of their sperm.

ICSI is indicated for men with sperm problems such as:

• low sperm count
• poor sperm motility
• high percentage of abnormal sperm
• men with sperm anti-bodies.
• retrograde ejaculation (ejaculation of the sperm into the urinary bladder)
• where IVF has been previously unsuccessful.

We also offer the following procedures which may be required to assist your ICSI procedure.

Percutaneous Sperm Aspiration (PESA)

PESA is usually the first treatment option we suggest if the male partner has no sperm in his semen. It is relatively painless and requires no surgical intervention and has high retrieval rates – between 80% and 90%. A fine needle is inserted through the scrotum into the epididymis from which fluid is gently removed by aspirating it through the needle. The fluid is then analyzed for sperm content and motility. PESA usually takes about 10 to 20 minutes and requires only local anesthetic.

Testicular Sperm Extraction (TESE)

If no sperm is found in the epididymal fluid, a needle is gently inserted into the testes. This needle removes a small sample of tissue, which is then examined for sperm in our laboratory. A variant of this procedure involves a small surgical incision in the testis, called a testicular biopsy.