ICSI (intracytoplasmic sperm injection)

What ICSI involves

In standard IVF, eggs collected from the ovaries are placed in a dish with a prepared sample of sperm, and fertilisation is left to happen on its own. ICSI changes that one step. In the words of the UK fertility regulator, the HFEA, “a skilled embryologist (embryo specialist) will inject a single sperm into the egg.”

Nothing else about the course of treatment changes. The HFEA describes ICSI as “performed as part of in vitro fertilisation (IVF)”, and says the treatment is otherwise “exactly the same as with IVF”. The IVF page explains that sequence.

When it is used

The HFEA says “Your doctor may recommend ICSI if: you have a very low sperm count”, or if “your sperm are abnormally shaped (poor morphology) or they don't move normally (poor motility)”.

ICSI is also how sperm collected surgically is used. When sperm is taken directly from the epididymis or the testis, by TESA or PESA or by micro-TESE, the HFEA notes: “You'll need to have a fertility treatment like ICSI to use your sperm.”

Whether it is appropriate in a particular case is a clinical decision for the treating doctor. This directory does not make that judgement.

Variations: IMSI and PICSI

IMSI and PICSI change how the sperm for injection is chosen, not the injection itself. The HFEA lists both as treatment add-ons, which it defines as “optional non-essential treatments or tests that may be offered in addition to such proven fertility treatment”, and publishes its own rating of the evidence for each. Clinics in this directory whose websites name IMSI or PICSI: 57.

What the regulator says about risks

The HFEA states: “ICSI carries slightly more risks than some other fertility treatments, including a risk that eggs may be damaged when they're cleaned and injected with sperm.” It adds: “It has been suggested that the use of ICSI may also be associated with long-term health issues for the children born. However, we cannot prove this either way until we have more conclusive evidence.”

It lists “Risks that may be associated with ICSI include:”

• “certain genetic and developmental defects in a very small number of children born using this treatment; however, problems that have been linked with ICSI may have been caused by the underlying infertility, rather than the treatment itself”
• “the possibility that a boy conceived as a result of ICSI may inherit his father's, or donor's, infertility (it is too early to know if this is the case, as the oldest boys born from ICSI are still in their teens). However, where there is a clearly defined genetic cause of male infertility, particularly if it is associated with the Y chromosome, it is highly likely that male offspring will inherit their father's, or donor's, infertility.”

And: “There are also all the usual risks that come with IVF treatment.” Those are quoted in full on the IVF page. A clinic can explain how these apply in a particular case; this page cannot.

India’s ART (Regulation) Rules, 2022 set out two levels of clinic:

• A Level 1 clinic is one where “only IUI is carried out as part of treatment”.
• A Level 2 clinic is one where “all/advanced investigations, diagnostic and therapeutic procedures in ART are carried out”.

Because a Level 1 clinic may carry out only IUI, ICSI is Level 2 work.

That is why each clinic below shows the level the national registry records for it. Of the listings below, 200 are registered as Level 2, 27 as Level 1, and 94 have no level in the registry extract. This directory does not know why a Level 1 clinic names ICSI. A clinic may send patients to a partner Level 2 laboratory, or its website may describe services it does not provide on site. Ask the clinic where the ICSI itself is done, and check its registration on the National ART & Surrogacy Registry.