One of the most well-known types of assisted reproduction is IVF. But there’s actually a more precise procedure. In this blog, we break down what IntraCytoplasmic Sperm Injection is, as well as what the cost, risks and even side effects are.

What is ICSI?

ICSI, pronounced ‘ick-see’ can almost be considered a type of In-Vitro Fertilisation (IVF). Traditional IVF aims to mimic natural fertilisation by mixing eggs and sperm in a lab, but letting them fertilise on their own (it’s like putting them all on Tinder and letting them match by themselves).

But ICSI on the other hand involves analysing and selecting sperm, and injecting it directly into an egg with a micro-needle (not to oversimplify, but think of it like an arranged marriage).

When traditional IVF just isn’t right for you (for any number of reasons), ICSI just could be your thing.

Read on to find out what the procedure is like, who it’s for and if it’s the best route for you.

What’s the ICSI process like?

In most cases, ICSI sticks to the regular IVF schedule of Egg retrieval and sperm collection, up until the time of fertilisation — that’s when they diverge.

In traditional IVF, the eggs and sperm collected are kept together within media, in a tiny petri dish. They get to hang out in the incubator together for between 12-24 hours, to maximise the chances of conception. That’s when the magic happens.

With ICSI, the courtship is much longer and more personalised. Every mature egg gets assigned its very own sperm cell (or spermatazoon) for injection. Embryologists will choose good, healthy sperm using a variety of methods, including analysing their general physical appearance, behaviour and motility (how they swim).

They use a specific high power microscope that helps them view the sperm at 200x, helping them choose the most viable ones.

The semen sample is processed in the lab, and a tiny sample of the most viable ones are taken for the final stage of screening, at 200x.

Once the sperm is chosen and assigned, it’s injected into the egg to induce fertilisation. If everything goes well, that egg turns into an embryo, which then finds its cosy home in a uterus after an embryo transfer.

Why would I choose ICSI over IVF?

Depending on the underlying cause of your specific type of infertility, ICSI may or may not be right for you. Let’s discuss a few of the favourable conditions:

1. Severe Male-Factor Infertility

If your obstacle is sperm quality or low sperm count, ICSI is worth exploring. Severe male factor infertility could benefit from ICSI as they go down to the details and tend to pick the best of the lot, compared to traditional IVF where they would still have to compete among other sperm.

1. Frozen Eggs

In fact, when you freeze eggs, in a way, you commit to ICSI. Since they are frozen in media, and then in liquid nitrogen, their outer layer (the zona pellucida) becomes quite hard, making it hard for sperm to penetrate through, like they would in IVF. ICSI bypasses this issue by using a micro-needle to inject the cell.

1. Genetic testing

ICSI is also recommended for people who are considering a type of procedure called Preimplantation Genetic Testing (PGT-M, which screens for monogenic disorders). This is used in cases when one partner could risk passing a single gene-related genetic abnormality to their child.

1. Previous Fertilisation Failures

If IVF or other kinds of assisted reproduction have failed for you, ICSI might be a good next step.

ICSI may not have been crafted for male-factor infertility, but it’s showing a lot of promise in other cases related to fertilisation failure. It's becoming more and more common as an assisted reproduction measure.

We’re still not 100% clear on whether it's better than IVF for people who aren’t dealing with any of the conditions we discussed above. In fact, a 2021 study revealed that for women over 35 without male-factor infertility, traditional IVF performed better. And yet another study from 2019 found that if you exclude male-factor infertility and age as parameters, ICSI showed worse results than IVF.

On average in India, one ICSI cycle can cost anywhere between INR 1-3 Lakhs (including medication, consultation, etc.), whereas a single round of IVF could be between INR 60-80k.

Are there any risks with ICSI?

The waters are a little murkier here. Many studies hint at a difference in the child’s health between ICSI and IVF, but the reasons aren’t always clear. For many, it means the risk of passing on any traits related to male-factor infertility to the child.

In 2016, the CDC also reported that ICSI might bring along increased health risks for children, including "chromosomal abnormalities, autism, intellectual disabilities, and birth defects," when compared to kids conceived via regular IVF.

In India, ICSI is considered to be a procedure associated with low risk. Of course, doctors do acknowledge the increased potential for birth defects, multiple pregnancies, etc., and do not recommend going for ICSI with every IVF cycle.

What’s the success rate for ICSI like?

By and large, ICSI is said to have a 25% success rate after just 1 round.

But the twist is that many ICSI-linked risks may not be pointing out issues with the procedure, but instead might be linked to the underlying infertility conditions of the biological parents.

And even though with ICSI those risks are statistically higher, on the whole, they’re small enough to consider having a conversation with your doctor.

Getting started with Arva

Embarking on fertility treatments involves important talks with healthcare experts to understand your fertility and hormones. It may feel overwhelming at first, but Arva is here to make it simpler. Our at-home fertility test is a first step for women thinking about Intra-Cytoplasmic Sperm Injection (ICSI) or wanting to check their hormonal levels.

Knowing what ICSI is and how it can help you is crucial. Arva is here to give you straightforward information, so you can confidently decide what's best for you.

TL;DR:

• ICSI is a nonsurgical procedure through which a single sperm cell is injected into an egg for fertilisation.

• Embryologists will choose good, healthy sperm using methods that test physical appearance, behaviour and motility.

• People with some conditions have better success with ICSI like:

  • Male-factor infertility

  • Frozen Eggs

  • Genetic Testing

  • Previous Fertilisation Failures

• For people without these underlying conditions, the success rates of ICSI vs. IVF is require more studies to have conclusive evidence.

• In India, ICSI is considered to be a procedure associated with low risk. But doctors do not recommend opting for ICSI with every IVF cycle.