What You Should Know About ICSI-IVF

What ICSI-IVF Is, Why It's Done, and Whether It's Safe

Microscopic image of ICSI-IVF being performed
ICSI-IVF is when the embryologist directly injects a single sperm into an egg. Science Photo Library - ZEPHYR. / Getty Images

ICSI-IVF, which is pronounced ick-see IVF, stands for intracytoplasmic sperm injection with in vitro fertilization. During regular IVF, many sperm are placed together with an egg, in hopes that one of the sperm will enter and fertilize the egg on its own. With ICSI-IVF, the embryologist takes a single sperm and injects it directly into an egg.

Some fertility clinics recommend ICSI for every IVF cycle.

Others reserve the treatment for those with severe male infertility or another medically indicated reason.

There are good arguments against using ICSI "just because." (The risks of ICSI-IVF are below.)

With that said, ICSI-IVF has enabled many infertile couples to get pregnant when, without it, they would not have been able to conceive using their own eggs and sperm.

Why Is ICSI-IVF Done?

ICSI-IVF is typically used in cases of severe male infertility, including:

  • Very low sperm count (also known as oligospermia)
  • Abnormally shaped sperm (also known as teratozoospermia)
  • Poor sperm movement (also known as asthenozoospermia)

If a man does not have any sperm in his ejaculate, but he is producing sperm, they may be retrieved through testicular sperm extraction, or TESE.

Sperm retrieved through TESE require the use of ICSI.

ICSI is also used in cases of retrograde ejaculation if the sperm are retrieved from the man's urine.

Severe male infertility isn’t the only reason ICSI-IVF is used. Other reasons include:

  • Very few eggs were retrieved: in this case, ICSI may be used to improve the odds of having a healthy embryo to transfer.
  • Previous IVF cycle had few or no fertilized eggs: Sometimes, a good number of eggs are retrieved, and sperm counts look healthy, but no eggs get fertilized. In this case, during the next IVF cycle, ICSI may be tried.
  • Frozen sperm are being used: if the thawed sperm don’t appear especially active, ICSI-IVF may be recommended.

What Is the Procedure for ICSI-IVF?

ICSI is done as a part of IVF. Since ICSI is done in the lab, your IVF treatment won't seem much different than an IVF treatment without ICSI.

As with regular IVF, you'll take ovarian stimulating drugs, and your doctor will monitor your progress with blood tests and ultrasounds. Once you've grown enough good-sized follicles, you'll have the egg retrieval, where eggs are removed from your ovaries with a specialized, ultrasound-guided needle.

Your partner will provide his sperm sample that same day (unless you're using a sperm donor or previously frozen sperm.)

Once the eggs are retrieved, an embryologist will place the eggs in a special culture, and using a microscope and tiny needle, a single sperm will be injected into an egg. This will be done for each egg retrieved.

If fertilization takes place, and the embryos are healthy, an embryo or two will be transferred to your uterus, via a catheter placed through the cervix, two to five days after the retrieval.

You can get more detailed information here in this IVF Treatment Step by Step.

How Much Does ICSI-IVF Cost?

The ICSI procedure itself costs between $1,400 to $2,000. This is on top of the general IVF cost, which on average costs $12,000 to $15,000. It may cost more than this if other IVF options are being used.

What Are the Risks of ICSI-IVF? Is It Safe for the Baby?

ICSI-IVF comes with all the risks of a regular IVF cycle, but the ICSI procedure does introduce additional ones.

A normal pregnancy comes with a 1.5% to 3% risk of major birth defect. ICSI treatment carries a slightly increased risk of birth defects, but it's still rare.

Some birth defects are more likely to occur with ICSI-IVF, specifically Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, and sex chromosome abnormalities.

They occur in less than 1% of babies conceived using ICSI with IVF.

There is also a slightly increased risk of a male baby having fertility problems in the future. This is because male infertility may be passed on genetically.

These additional risks are why many doctors are saying ICSI should not be used for every IVF cycle. It's one thing if you need ICSI to conceive. Then, you can discuss with your doctors the pros and cons of using this assisted reproduction technology.

However, if you can have a successful IVF cycle without ICSI, why risk even the slight increase in birth defects? 

What Is the Success Rate for ICSI-IVF?

The ICSI procedure fertilizes 50% to 80% of eggs.

You might assume all eggs get fertilized with ICSI-IVF, but they don’t. Fertilization isn’t guaranteed even when a sperm is injected into the egg.

Also, even if fertilization takes place, the embryo may stop growing.

However, once fertilization happens, the success rate for a couple using ICSI with IVF is the same as a couple doing regular IVF treatment.


Patient Fact Sheet: Intracytoplasmic Sperm Injection (ICSI). American Society of Reproductive Medicine. Accessed online July 1, 2009. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ICSI-Fact.pdf