If you have been in the world of infertility for any amount of time, you probably feel like you need a cheat sheet to keep track of the abundance of fertility acronyms that are involved in the process: TTC, IVF, IUI, PIO, ICSI. The list is seemingly never-ending, and it can be daunting to those who are entering the already stressful world of fertility treatments.

IVF, or in-vitro fertilization, is a form of assisted reproductive technology in which an egg is fertilized by sperm outside of the body. After fertilization, if a viable embryo is created, it can then be transferred to the intended parent or gestational carrier. In traditional IVF, up to thousands of sperm are placed with an egg on a laboratory dish, with the intended outcome of one of the sperm penetrating the egg and leading to fertilization.

ICSI, or intracytoplasmic sperm injection, is an IVF procedure in which a single high-quality live sperm is selected under a microscope. After selecting the healthy sperm, the egg is fertilized through the direct injection of the sperm into the center of the egg or the cytoplasm. IVF can be done without ICSI, but it is often recommended to achieve optimal results – in other words, to give you your best chance at creating viable embryos for transfer.

So, now that we have the broad definitions out of the way, in what cases is IVF with ICSI most commonly recommended?

Infertility Due to Sperm Abnormalities

The most common reason for the use of ICSI in an IVF cycle happens when a contributing cause of infertility is a male factor. A semen analysis is the first step in checking for sperm abnormalities, which can include:

  • Low Sperm Count: A low sperm count is diagnosed when a patient has fewer than 15 million sperm per milliliter.
  • Low Sperm Motility: Sperm motility is the sperm’s ability to move. In a healthy sperm motility measurement, a forward progression of at least 25 micrometers per second is seen.
  • Abnormal Sperm Morphology: Morphology takes a look at the size and shape of sperm. In a semen analysis, the morphology results are reported as the percentage of normal sperm. A scale called Kruger Strict Criteria is used by many doctors to evaluate sperm morphology, with scores as follows
    • Over 14 percent of sperm have normal morphology – a high probability of fertility
    • 4-14 percent – fertility slightly decreased
    • 0-3 percent – fertility extremely impaired

Ways to Improve Sperm Quality Before Trying IVF with ICSI

If fertility testing has been completed and sperm quality is the only issue found, there are ways to improve fertility with lifestyle changes. The American Society for Reproductive Medicine recommends not using tobacco or recreational drugs, as well as limiting your consumption of alcohol and caffeine. Lifestyle changes don’t immediately impact sperm quality, so these are not an overnight fix. In fact, it can take up to three months for any changes in the sperm to become measurable in a follow-up semen analysis.

Dual-Factor or Unexplained Infertility

In some cases, eggs may not be fertilized by traditional IVF, despite the fact that the sperm used was of healthy, quality condition. In this case, ICSI may be used in the following IVF cycle in order to help raise the fertilization rates.

ICSI Fertilization Success Rates

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ICSI is shown to fertilize anywhere from 70-85% of eggs - a great number! However, as is the case with traditional IVF, fertilization is just the first step. ICSI is not a guarantee when it comes to the creation of a viable embryo. Issues that may occur following ICSI fertilization include the fact that not all fertilized eggs will continue to grow after fertilization, or may stop growing before the embryos reach days 3-7.

ICSI is a wonderful tool to help fertilization take place, but once the egg is fertilized, the chances of a live birth are the same if the patients have used IVF with or without ICSI.

The Bottom Line? Talk to Your Doctor

If you’re considering using IVF with ICSI to conceive, the best thing to do is talk over all of your options with your provider. And remember, you should always advocate for yourself to get the testing you seek on your fertility journey. 

Lindsey Williams is a library worker and writer who lives in Arizona with her husband and their dog, Peaches. After 5 years of trying to conceive with dual-factor infertility, she is currently expecting her first child conceived with the help of IVF.