When sperm count, movement or shape is a concern, or when eggs did not fertilise in an earlier IVF cycle, ICSI may offer a way forward. Dr. Sunita Arora, an infertility specialist with over 23 years of experience, offers consultations for ICSI at her clinics in Safdarjung Enclave and Greater Kailash II, South Delhi.
This page explains what ICSI is, who it helps, who may not need it, and what each step involves, so you can make decisions with clear information.
Intracytoplasmic sperm injection (ICSI) is a form of IVF in which an embryologist selects a single sperm and injects it directly into an egg under a microscope. The fertilised eggs are grown in the laboratory for a few days, and one or more resulting embryos are then transferred to the uterus. Everything else in the cycle, including hormone injections, egg collection and embryo transfer, is the same as standard IVF.
ICSI is generally considered when:
ICSI is sometimes offered routinely, but good-practice guidance from fertility bodies recommends standard IVF when there is no male-factor problem, because there is currently no good evidence that ICSI improves outcomes in that situation, and it adds cost and some additional procedural risk. ICSI also cannot make up for poor egg quality. Dr. Arora will recommend ICSI only if there is a clear reason, and she will explain that reason to you.
A thorough assessment of both partners comes first. For the male partner this usually includes a semen analysis, which may be repeated, and, depending on the results, hormone tests, an examination and an ultrasound. If sperm count is very low or absent, genetic tests and counselling may be advised. For the female partner, ovarian reserve, uterine health and the fallopian tubes are assessed, as for any IVF cycle.
When no sperm are found in the ejaculate, sperm can sometimes be retrieved directly from the epididymis or testis through a short procedure, commonly known as PESA, TESA or TESE, and then used for ICSI. This is carried out with the appropriate specialist and depends on the cause. The chance of finding sperm cannot be promised in advance, and the options will be discussed with you in detail.
A clear, guided walkthrough of what to expect at every stage of your intracytoplasmic sperm injection cycle.
Hormone injections help the ovaries develop several eggs, while scans and blood tests track your response.
Eggs are collected through the vagina under ultrasound guidance with sedation. A sperm sample is produced the same day, or previously frozen or surgically retrieved sperm is used.
The embryologist injects one sperm into each mature egg. Only mature eggs can be used.
Eggs are checked the next day to see whether they have fertilised, and the embryos are monitored for several days.
One or more embryos are placed in the uterus. Suitable spare embryos may be frozen. A pregnancy test follows about two weeks after the transfer.
ICSI shares the general risks of IVF, including ovarian hyperstimulation syndrome (OHSS), twins or more if several embryos are transferred, and ectopic pregnancy. Specific to ICSI, some eggs may be damaged during injection or may not fertilise. A very small number of genetic or developmental conditions have been reported in children conceived this way, and these may be linked to the underlying infertility. If a genetic cause of male infertility is found, a son may inherit it.
Male-factor infertility can be hard for couples to talk about. It is nobody’s fault. Dr. Arora encourages both partners to attend, ask questions and take the time they need.
Counselling can help, especially after an unsuccessful cycle.
Dr. Arora is a gynaecologist and obstetrician with a fellowship in reproductive medicine and IVF training at the Mount Sinai programme in New York.
Her special interests include infertility, IVF and IUI, and she runs FOGSI-accredited courses in IUI and IVF for gynaecologists.
Patients can expect personal attention, honest advice and transparency at every step.
You can see Dr. Arora at Dr Sunita Arora Fertility and Gynae Clinic in Safdarjung Enclave or at Fortis La Femme, Greater Kailash II.
Dr Sunita Arora Fertility and Gynae Clinic
Fortis La Femme, South Delhi
Many patients also travel from nearby areas such as Hauz Khas, Green Park and Malviya Nagar. See the Clinics page for addresses and timings.
Find answers to common questions about intracytoplasmic sperm injection, procedure steps, and realistic expectations.