Intra cytoplasmic sperm injection (ICSI) is a process of helping sperms to fertilise eggs.

In the early days of IVF, many couples with low sperm numbers, abnormal looking sperm and low sperm motility (poor swimmers) underwent IVF, but the sperm were unable to fertilise the eggs resulting in no embryos for transfer into the womb, and no prospect of a family unless they resorted to donor sperm. ICSI was then developed in 1992 as a process of injecting a single sperm into the egg itself, to ensure that the sperm could deliver its genetic information into the egg and trigger the egg’s transformation into an embryo.

This revolutionised treatment for this group of couples, enabling them to have the same success rates as other couples having IVF.

The process is very similar to an IVF cycle with the same careful hormonal stimulation of the ovaries to produce several eggs. These are then collected under sedation using a transvaginal approach and ultrasound guidance and taken into the laboratory.

Semen (fluid containing sperm) is prepared to allow embryologists to obtain the best sperm available. The egg is steadied with gentle suction, and then a single sperm is selected, its little tail is broken to immobilise it and it is injected carefully into the egg. The injected eggs are then incubated and observed as normal.

The ICSI technique is also helpful in other situations:

• - Where the man has no sperm in his semen due to an obstruction. An example of this might be in the situation of a failed vasectomy reversal, where sperm can be surgically taken from the collecting system of the testis and used to fertilise eggs. ICSI has to be used in this situation as these sperm have not been prepared to meet eggs naturally and would not be able to fertilise them.

• - Men with poorly functioning testes and no sperm in the semen may undergo a biopsy procedure to look for sperms and again these sperm will need the ICSI technique to be able to fertilise eggs.

• - As ICSI became so successful, some clinics advocate this treatment for all IVF cycles, to overcome the rare but distressing situation of unexpected failure of fertilisation with a normal semen sample, but this is not generally advised.

What are the risks of ICSI?

• - A slight increase in some very rare genetic conditions has been noted in some studies but not others, when ICSI babies are compared to IVF babies. It is possible, however, that this may be due to the underlying fertility condition, rather than the technique.

• - Sons born from fathers with very low sperm counts may inherit this condition, but we will need to wait for them to grow up before we know.

• - A small proportion of eggs may be damaged by the manipulation (around 5% is generally considered acceptable).

How can LWC help?

We have been established since 1992 and have used ICSI to help couples since its initial development. Our IVF and ICSI pregnancy rates are amongst the best in Wales and the West, and you should check this on the HFEA website.