Intra-Cytoplasmin Sperm Injection (ICSI) FAQs
ICSI is an established method of insemination, however, patients have many questions when they embark on the program.
What additional tests are required for ICSI?
Additional sperm tests are the most common and if there is a problem with sperm production then a testicular biopsy (where a small piece of testicular tissue is removed) may be required. Blood tests may be required to reassess hormone levels.
Some couples will need to undergo genetic testing to assess the chances of passing on an inheritable condition to any children born as a result of treatment. This is of particular importance to men with poor sperm characteristics as in some cases this can be caused by genetic defects.
How does ICSI differ from standard IVF?
In conventional IVF treatment approximately 200,000 sperm are placed next to the egg in a dish for fertilisation to take place, whereas during ICSI a single sperm is injected directly into the centre of the egg.
What are the risks associated with ICSI?
All the risks and side effects associated with IVF are also associated with ICSI, more information is available in the Treatment Problems section. In addition ICSI has specific risks associated with assisting fertilisation which wouldn’t occur naturally, including:
The increased possibility that a genetic abnormality could be passed on to the male child and, in particular, a much higher risk that the male offspring may also be infertile and require treatment to achieve a pregnancy. These include;
Congenital bilateral absence of the vas deferens (CBAVD).
Some men who have no sperm in their semen are found to have congenital bilateral absence of the vas deferens (CBAVD). In this condition the tubes that carry sperm from the testes to the penis are missing. Two thirds of men with CBAVD are also carriers of certain Cystic Fibrosis mutations. Men with CBAVD and their partners may therefore wish to undergo genetic testing before proceeding with ICSI.
Y chromosome missing/deleted
A small proportion of sub-fertile men have parts of the Y chromosome missing (deleted). Certain genes on the Y chromosome have been shown to be involved in the production of sperm, and the deletion of these genes may be responsible for some men having few or no sperm in their semen. Consequently, using sperm with such deletions to create an embryo may result in the same type of sub-fertility being passed on from father to son.
Abnormal numbers or structures of chromosomes
Abnormal numbers or structures of chromosomes, particularly the sex chromosomes (X and Y), may be associated with infertility in both men and women, and babies born from ICSI treatment may have a slightly increased risk of inheriting these abnormalities. Studies have found that up to 3.3% of male patients referred for ICSI have chromosomal abnormalities. It is estimated that up to 2.4% of the wider population have a chromosomal abnormality.
Possible damage to the egg during the sperm injection procedure which could potentially lead to abnormal development of any offspring. This is only a theoretical risk, however, and to date there is little evidence to suggest this is true.
Novel chromosomal abnormalities
The complexity of the process of egg and sperm production means that even if an individual possesses a normal number of chromosomes their gametes could potentially have an abnormal number. It is not possible to detect beforehand which eggs or sperm have chromosomal abnormalities and gametes that might not have been able to participate in natural fertilisation could therefore be used in ICSI. Babies born after ICSI have been reported to have new chromosomal abnormalites in up to 3% of cases. The rate in the general population is around 0.6%.
There is not yet any clear evidence whether ICSI results in higher rates of birth defects. The number of babies reported to have major birth defects, such as cleft palette, is between 1 and 5% in both the general population and in babies born following ICSI. Studies suggest that minor abnormalities occur in up to 20% of ICSI babies, compared to up to 15% of the general population. For example, one recent study has shown a 3 fold excess risk in the rate of the relatively rare problem hypospadias following ICSI. More studies are needed in order to gain further insight into these possible defects.
One recent study that followed up a relatively small number of children has given an indication of possible delays in mental development at one year in some children born following ICSI. Other studies have not shown this link and further research is needed in this area.
With ICSI, it is possible that abnormal gametes, which would not usually be able to produce a viable embryo, could be used. This may increase the chance of an abnormal embryo being formed. However, most abnormal embryos will not implant into the womb and grow, but some might, leading to a possible higher risk of miscarriage. It has been reported that the risk of miscarriage increases in proportion to the severity of male infertility. More information is available on the Miscarriage page.
If I become pregnant, how will I know if there is a problem?
Tests will be offered in the early stages of any pregnancy including blood tests to assess the risk of Down’s syndrome and spina bifida. A detailed ultrasound scan will also be done to assess the baby’s development. Depending on their age some individuals will be offered an amniocentesis (where some fluid is taken from the sac surrounding the fetus) to check the baby’s genetic make-up.
Further information about tests, scans and antenatal care can be found in the Patient Information section.
How successful is ICSI?
Normally about 60-70% of eggs will fertilise following ICSI. The pregnancy rate for each embryo transfer is at least as good as for conventional IVF treatment.
Detailed information about The Fertility Centre’s success rates can be found on the Success rates page.
How much will it cost?
If you do not qualify for NHS treatment you will receive details of the current costs for treatment. In general ICSI is about 30% more expensive than IVF. This extra charge takes into account the large amount of laboratory time that is taken up with the sperm injection and the huge costs of training staff and purchasing the necessary precision micro-manipulation equipment.
More details of treatment pricing for private patients can be found on the Fees page.
How long is the waiting list?
If you qualify for NHS treatment the nursing or clinical staff will inform you when you come through for treatment. If you do not qualify for NHS treatment and wish to be treated privately then there is no waiting list. All you need do is ask your GP for a private referral.
The current waiting times for fertility treatment are listed on the Waiting Times page.
Long term follow up
Because of the nature of the treatment and the fact that relatively little is known about the long term implications of treatment it may be necessary for us to follow up any children born by ICSI for up to 30 years. Your co-operation in this matter would be needed and greatly appreciated if it is to be a success.