Question 54. Who needs ICSI, and how can my reproductive endocrinologist be certain that I need it?

So as you may recall from Question 53, ICSI is that crazy technique that involves taking a sperm and inserting it into the egg to induce fertilization.....hard to believe that it works but there you have it.

Sometimes it is not that easy to figure out who needs ICSI and who doesn't. I have a nice couple that first came to me a few years ago with mild male factor infertility as the apparent cause. Ultimately they decided to pursue Natural Cycle IVF and were successful on the 2nd attempt of Natural Cycle IVF with ICSI. We used ICSI as they had no previous pregnancies and there was some mild male factor. We have tended to err on the side of ICSI with Natural Cycle IVF as there is only 1 egg and if we don't get fertilization then the cycle is a bust....

In any case, following delivery of a healthy baby from that first NC IVF cycle they returned last year for another round of NC IVF. However, we just couldn't get them pregnant. Several cycles ended in failed fertilization in spite of ICSI. They had no interest in any treatment other than NC IVF as they had moral/philosophical issues with the fertilization of multiple eggs.

So for NC IVF cycle #6, I made the bold recommendation to defer ICSI and go with just IVF. We got a nice egg, it fertilized, it grew, I did the ET of a perfect blastocycst and they are currently pregnant with Baby #2. Was it the IVF without ICSI that did it? Was it just a good egg? Was it the fact that DrG had been off that weekend and was well-rested for a Monday morning ET? Who knows? I am just glad that their persistence paid off.....

Another example of having to treat individuals and not applying cookie-cutter protocols to yoru patients....

So with all that said, here is the latest excerpt from our 100 Questions and Answers about Infertility book. Don't forget to respond to the poll so I can understand who besides my Mother reads this blog....


54. 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. Thereore, men with unproven fertility whose sperm count, motility, or morphology is suboptimal are appropriate candidates for 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 fertilization failure in 20-40% of IVF cycles. By using ICSI, the eggs are “forced” to fertilize, and the pregnancy rates are usually high. Fertilization rates with ICSI are usually 60-80% depending upon egg and sperm factors.