To ICSI or not to ICSI, that is the Question

Several years ago I was having a beer with one of the Chief Embryologists at a well-known fertility clinic. The conversation turned to ICSI and I asked him what criteria he used to determine whether ICSI was indicated. He replied, “we only do ICSI on patients who really need it.” When I suggested that his >70% ICSI rate seemed a bit high, he walked off to chat with someone else…Oh well, so much for friendly professional banter which is why I am terrible at cocktail parties.

So can a physician be absolutely certain that ICSI is needed? The following “Question of the Day” looks at this question and tomorrow’s question will give some additional thoughts on this issue.

58. Who needs ICSI, and how can my reproductive endocrinologist be certain that I need it?

Most couples undergoing treatment with IVF do not require ICSI. The most common indication for ICSI is male factor infertility associated with an abnormal semen analysis. For example, men with unproven fertility whose sperm count, motility, or morphology is suboptimal may require IVF with ICSI to ensure fertilization of the ova. Another common indication for ICSI is unexplained infertility. In these couples, neither the man nor the woman has any apparent fertility-related problems. Their diagnostic evaluation is entirely normal, yet infertility exists. In such couples, traditional IVF may result in failure of the man’s sperm to fertilize the woman’s eggs. By using ICSI, the eggs are “forced” to fertilize, and the pregnancy rates are usually high.