ICSI – Intracytoplasmic Sperm Injection for Male Infertility

Profilbild des Autors
written by Zappelphilipp Marx•27 May 2025
Microinjection: Embryologist performing ICSI – sperm entering an oocyte

Intracytoplasmic Sperm Injection (ICSI) is the principal micromanipulation technique used when conventional in vitro fertilisation (IVF) fails due to severe male‐factor infertility. This guide covers everything—from indications, procedure and costs to success rates, risks and the Indian regulatory framework.

What Is ICSI—and When Is It Used?

Under the microscope, a single sperm is immobilised and injected directly into the cytoplasm of a mature oocyte using a fine glass pipette. ICSI is indicated for severe oligo‐astheno‐teratozoospermia (OAT), azoospermia with TESE/micro‐TESE retrieval, high sperm DNA fragmentation, anti‐sperm antibodies or repeated fertilisation failure in previous IVF cycles. Genetic screening (e.g. AZF deletion or CFTR mutation panels) is mandatory in severe cases to counsel on risks of transmission to male children.

Quick Comparison of Fertilisation Methods

  • ICI / Intracervical Insemination – Home Insemination
    Sperm sample is placed near the cervical opening via syringe or cup. Suitable for mild fertility issues or donor sperm; lowest cost and maximum privacy.
  • IUI – Intrauterine Insemination
    Washed sperm are delivered into the uterine cavity via catheter. Ideal for moderate male‐factor infertility, cervical issues or unexplained infertility; clinically straightforward, moderate cost.
  • IVF – In Vitro Fertilisation
    Multiple stimulated eggs are combined with processed sperm in the laboratory. Standard for tubal blockage, endometriosis or failed IUI; higher success rates, higher cost.
  • ICSI – Intracytoplasmic Sperm Injection
    A single sperm is microinjected into the egg. Precision solution for the most severe male‐factor infertility or TESE samples; highest cost but best chance when sperm quality is extremely low.

How Much Does ICSI Cost in India?

ICSI is an add-on to a standard IVF cycle. In India, an IVF cycle typically costs ₹150,000–₹250,000 (including scans, monitoring, egg retrieval, laboratory culture and transfer). The ICSI surcharge usually ranges from ₹20,000 to ₹50,000.

Out-of-Pocket & Insurance: Nearly all patients in India pay out-of-pocket. Few corporate health plans offer partial coverage for IVF, and almost none cover the ICSI add-on. Always verify your policy benefits.

Additional Costs: Testicular biopsy (TESE) ₹50,000–₹150,000; genetic tests ₹10,000–₹25,000; preimplantation genetic testing for aneuploidy (PGT-A) ₹100,000–₹200,000; embryo cryopreservation ₹20,000–₹30,000 per year.

Step-by-Step ICSI Procedure

  1. Evaluation & Counselling: Semen analysis, hormone profile, ultrasound, infectious disease screening, genetic testing.
  2. Ovarian Stimulation: 8–12 days of gonadotropins with frequent monitoring; “mild” protocols for high responders.
  3. Egg Retrieval & Sperm Collection: 34–36 hours after hCG/LH trigger; TESE/micro-TESE if no ejaculate sperm.
  4. Sperm Selection: Density gradient centrifugation, IMSI or PICSI for enhanced DNA integrity.
  5. Microinjection: One sperm per mature MII oocyte via micromanipulator.
  6. Embryo Culture & Time-Lapse Imaging: Continuous observation through day 5 (blastocyst). Optional PGT-A/PGT-M.
  7. Embryo Transfer or Freeze-All: Single-embryo transfer to minimise multiple gestation; freeze-all when estradiol levels are high, with subsequent frozen embryo transfer in a natural or medicated cycle.
  8. Luteal Phase Support: Progesterone supplementation (vaginal/IM/oral) up to 10–12 weeks of gestation.
  9. Pregnancy Test & Early Scan: Serum β-hCG test 10–14 days post–transfer; first ultrasound around 6–7 weeks.

Success Rates – Realistic Figures

Fertilisation rates with ICSI are 70–80 %. Clinical pregnancy rates per transfer mirror IVF and depend mainly on maternal age:

  • Under 35: 45–55 %
  • 35–37: 35–45 %
  • 38–40: 25–30 %
  • Over 40: < 15 %

With additional frozen embryo transfers, the cumulative take-home baby rate for women under 35 often exceeds 60 %.

How to Improve Your Chances

Lifestyle: Maintain healthy BMI, quit tobacco, limit alcohol to < 5 units/week, daily folic acid + vitamin D, moderate exercise.

Male-Factor Support: Antioxidant-rich diet (vitamins C/E, CoQ10, omega-3) and 3-month abstinence from nicotine & steroids to reduce DNA fragmentation.

Medications:DHEA & CoQ10 may aid low responders (evidence limited—consult your clinician).

Risks & Side Effects

  • OHSS (Ovarian Hyperstimulation Syndrome): Rare with antagonist protocols and freeze-all (< 1 %).
  • Multiple Pregnancy: Risk linked to number of embryos transferred; single-embryo transfer keeps multiples < 5 %.
  • Epigenetic Concerns: Slight absolute increase in imprinting disorders (< 1 %).
  • Emotional Stress: High financial and emotional load; consider counselling support.

Regulatory Framework (India)

  • ICMR National Guidelines for ART 2017 regulate laboratory and clinical standards.
  • Registration of ART clinics with ICMR mandatory under the Surrogacy (Regulation) Act 2021.
  • No statutory limits on embryo culture duration, but ethical guidelines advise up to 5 days.
  • No mandated insurance coverage for IVF/ICSI—patients bear full cost.

Key Guidelines & Studies

Conclusion

Intracytoplasmic Sperm Injection is the most precise method for overcoming severe male-factor infertility. With advanced micromanipulation, a high-quality lab and single-embryo transfer, ICSI achieves up to 55 % success per fresh transfer in younger patients. Comprehensive counselling on costs, risks and emotional support, together with genetic consultation, helps patients make informed decisions and maximise outcomes.

Frequently Asked Questions (FAQ)

In conventional IVF, eggs and sperm are placed together and fertilisation occurs naturally. With ICSI, a single sperm is injected directly into the egg cytoplasm, bypassing sperm motility or morphology issues.

Severe OAT syndrome, azoospermia requiring TESE/micro-TESE, high sperm DNA fragmentation, anti-sperm antibodies, or fertilisation failure in prior IVF cycles.

India: ₹150,000–₹250,000 per IVF cycle (ICSI add-on ₹20,000–₹50,000), paid out-of-pocket; insurance coverage is rare.

Fertilisation in 70–80 % of injected eggs. Clinical pregnancy per transfer: 45–55 % (<35 years), 35–45 % (35–37), 25–30 % (38–40), <15 % (>40). Cumulative live-birth rate often exceeds 60 % with frozen transfers.

About 10–30 % may have activation failures, immature chromatin or cytoplasmic defects. Egg quality is as crucial as sperm quality.

No—if viable sperm are retrieved, fertilisation and pregnancy rates are similar to ejaculate ICSI when handled by an experienced lab.

Evidence is mixed. High-magnification IMSI or hyaluronate-binding PICSI may slightly reduce miscarriage rates in severe teratozoospermia or high DNA fragmentation.

For patients aged 35 and above, recurrent pregnancy loss, or multiple ICSI failures, aneuploidy screening can reduce miscarriage rates and shorten time to pregnancy.

Multiple gestation risk depends on the number of embryos transferred. Single-embryo transfer keeps multiples below 5 %.

Yes—OHSS is driven by ovarian stimulation, not ICSI itself. Antagonist protocols, GnRH trigger and freeze-all minimise risk.

Studies show <1 % absolute increase in imprinting disorders (e.g., Beckwith-Wiedemann, Angelman), but overall risk remains very low.

Stimulation 8–12 days → retrieval on day 0 → embryo transfer on day 5 → pregnancy test ~4 weeks from start.

2–4 days of abstinence optimises semen volume and motility.

Maintain BMI 18.5–24.9, avoid smoking, limit alcohol to < 5 drinks/week, eat omega-3 rich foods, take daily folate (400 µg) & vitamin D, exercise moderately and manage stress.

In men, a 3-month course (CoQ10 300 mg/day, L-Carnitine 2 g/day) may improve motility. Evidence is moderate—please consult your doctor.

Modern vitrification yields comparable implantation and live birth rates. Frozen transfer has lower hormonal burden and no OHSS risk.

Combines mild stimulation (150–225 IU/day) with single-embryo transfer to reduce OHSS, multiples and cost—best suited for good prognosis patients.

If viable sperm are retrieved, fertilisation rates reach 60–70 % and pregnancy rates per transfer are similar to ejaculate ICSI in experienced labs.

Recommended in severe male-factor cases: AZF deletion screening, CFTR panel, karyotype analysis. Results guide treatment and genetic counselling.

Fertility counsellors, online support groups (RattleStork Community), local NGOs such as AFAI, and hospital-based counselling services.