Fertulity IVF
Fertulity IVF

Intracytoplasmic Sperm Injection (ICSI)

What is Intracytoplasmic Sperm Injection (ICSI)?

Intracytoplasmic Sperm Injection (ICSI) (Intracytoplasmic Sperm Injection) is an innovative assisted reproduction method used in cases of severe male infertility or when traditional in vitro fertilisation has not been successful.

At Fertulity, we use the ICSI method when the sperm is unable to penetrate the egg naturally, as this technique allows a selected sperm to be injected directly into the egg's cytoplasm with microsurgical precision. This bypasses obstacles such as low sperm motility or abnormal sperm morphology, increasing the chances of successful fertilisation.

ICSI differs from conventional IVF in that it does not rely on the natural union of the two cells, but on a process guided by the embryologist, with absolute control and a high success rate, always under the strict specifications of Fertulity.
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ICSI or Classic IVF?  The Main Differences in Fertilization

ICSI microfertilization and conventional in vitro fertilization (IVF) share common stages, but differ in critical aspects of the fertilization process. At Fertulity, we help each couple choose the right technique for their individual needs.
1

Fertilization method

In classic IVF, the eggs and sperm are placed together in the laboratory and fertilization occurs naturally if the sperm is able to penetrate the egg on its own.
In ICSI, the embryologist selects the best sperm and injects it directly into the egg using a special micro-needle.

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2

Male factor infertility

ICSI is recommended when the sperm has low motility, abnormal morphology, or a limited number, conditions that make natural fertilization difficult. Conventional IVF is suitable when the sperm has normal characteristics.
3

Fertilization success rates

ICSI offers increased fertilization rates, reaching 70–85% in cases of male infertility, depending on the quality of the eggs and sperm. In contrast, the success of conventional IVF decreases when there are serious problems with the sperm.
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When Is ICSI Used?

Intracytoplasmic Sperm Injection (ICSI) is not always the first-line approach in fertility treatment; however, there are specific cases where it offers a significant advantage. At FertUlity, we apply ICSI with precision and scientific justification in the following indications:

Severe Male Infertility

In cases of oligospermia, asthenozoospermia, teratozoospermia, or when sperm cannot naturally penetrate the egg.

Absence of Sperm in Ejaculate (Azoospermia)

Following sperm retrieval from the testes via TESA or Micro-TESE procedures.

Previous Failed IVF Cycles

When previous fertilization attempts were unsuccessful, even if everything appeared normal.

Unexplained Infertility

When no cause has been identified and ICSI helps overcome potential dysfunctions in sperm-egg interaction.

Use of Frozen Sperm

Especially when there is concern about motility or morphology after thawing.

Use of Donor Sperm or Eggs

To ensure optimal utilization of the genetic material in donation cases.

Preimplantation Genetic Testing (PGT)

To avoid contamination from additional sperm and ensure accuracy in genetic analysis.
The expert team at FertUlity carefully evaluates each case individually, selecting the most appropriate technique to maximize the success of fertilization.
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The ICSI Process Step-by-Step:

The ICSI (Intracytoplasmic Sperm Injection) procedure follows a fully controlled and highly targeted approach, aiming for safety and the highest possible success rate. Here are the stages in detail:

Success Rates & Effectiveness

ICSI is one of the most effective assisted reproduction techniques, especially in cases of male infertility. At Fertulity, ICSI fertilization rates range between 70% and 85%, even when sperm shows low motility, poor morphology, or has been surgically retrieved (e.g. via TESA or Micro-TESE). The success lies in the direct injection of a selected sperm into the egg, bypassing natural barriers.

In contrast, traditional IVF yields fertilization rates between 50% and 70%, which significantly drop in the presence of sperm issues. However, it's important to note that pregnancy success depends not only on the technique but also on egg quality and overall female health. That’s why at Fertulity, we apply personalized strategies to increase the overall likelihood of a successful pregnancy.

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Preparing for ICSI

The success of ICSI begins with proper and targeted preparation. At Fertulity, we place great importance on the early stages, crafting a personalized plan for every couple.
Step 1

Medical Evaluation and Detailed Fertility Assessment

The first step is a meeting with our medical team to collect complete medical history and identify any fertility-affecting factors. Women undergo ovarian reserve tests (AMH, FSH, AFC ultrasound), while men receive a semen analysis to assess sperm count, motility, and morphology. If signs of severe male infertility are present, additional tests such as DNA fragmentation or genetic screening are performed.
Step 2

Counseling and Informed Consent

Preparing for ICSI is not only medical but also psychological. We offer counseling sessions to help couples understand every aspect of the process—emotional, physical, and financial. Fertulity’s specialists explain every step clearly, answer questions, and guide you through signing the informed consent.
Step 3

Lifestyle Optimization and Physical Readiness

Before starting the cycle, we recommend lifestyle changes that can boost success rates: quitting smoking, reducing alcohol intake, nutritional support, regular exercise, and stress management. Nutritional supplements (such as folic acid or vitamins E and C) may be prescribed to improve egg and sperm quality.
At Fertulity, preparation is the foundation of a successful journey — and we give it the seriousness and personalized care it deserves.
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Other ICSI Techniques

IMSI Method – Intracytoplasmic Morphologically Selected Sperm Injection

IMSI is an advanced sperm selection technique used in IVF to maximize success rates.

At Fertulity, we use IMSI when sperm morphology or quality is suboptimal. The technique uses a high-magnification microscope to identify sperm with perfect morphological features. This allows the selection of the optimal sperm for microinjection, potentially reducing miscarriage risk and improving fertilization and implantation outcomes.

While scientific evidence is still evolving, IMSI is a high-precision personalized option, particularly suitable for cases with repeated failures or implantation difficulties, ensuring quality control at every treatment stage.

PICSI Method – Physiological Intracytoplasmic Sperm Injection

PICSI is an enhanced ICSI technique that improves sperm selection not only based on morphology and motility but also on functional capacity.

At Fertulity, we apply PICSI when the HBA test shows low hyaluronic acid binding or when DNA fragmentation index (DFI) is high—factors that can affect fertilization and embryo quality.

The technique involves selecting only mature, functional sperm that naturally bind to hyaluronic acid—mimicking natural fertilization—thus increasing the chances of successful outcomes. PICSI is especially recommended in cases of repeated IVF failure, male infertility, or surgically retrieved sperm, offering a tailored, advanced solution for couples.

Comparison Table Microinjection Techniques (ICSI, IMSI, PICSI)

Criterion ICSI IMSI PICSI
Full Name Intracytoplasmic Sperm Injection Intracytoplasmic Morphologically Selected Sperm Injection Physiological Intracytoplasmic Sperm Injection
Main Difference Uses a single sperm without advanced selection High-magnification morphological sperm analysis Sperm selected by binding to hyaluronic acid
Selection Type Based on motility & basic morphology Based on detailed head & acrosomal structure Based on natural maturation & function
Benefit Bypasses male fertility issues Better sperm selection in cases of poor morphology Minimizes DNA fragmentation – ensures sperm maturity
Recommended For Low sperm count or motility Repeated implantation failures / poor morphology Low HBA, high DFI, IVF failures

Microfertilization (ICSI) Frequently Asked Questions about ICSI

What additional tests are required for ICSI?

During ICSI preparation, additional tests are often necessary—especially when male infertility is suspected. At FertUlity, the process begins with a detailed semen analysis (spermogram) to evaluate sperm count, motility, and morphology. In some cases, a DNA fragmentation test may be performed to identify potential issues in the genetic material. If sperm count is very low or entirely absent, genetic testing may be recommended to detect chromosomal abnormalities. Simultaneously, the woman undergoes blood and hormonal tests (AMH, TSH, FSH) to develop a fully personalized treatment plan.

Will all eggs be fertilized during ICSI?

No, ICSI does not guarantee that all retrieved eggs will be fertilized. Only mature eggs are suitable for sperm injection. On average, 75–80% of retrieved eggs are mature enough to proceed with ICSI. The remaining ones are either immature or non-viable and cannot be used. Even among the mature eggs, fertilization depends on various factors, such as sperm quality and egg condition. At FertUlity, eggs are selected and processed with exceptional precision to increase the chances of successful fertilization.

Is genetic testing recommended before ICSI?

Preconception genetic testing can be a valuable tool in certain cases, particularly when there is severe male infertility such as azoospermia or extremely low sperm count. At FertUlity, we consider genetic screening when there is a heightened risk of transmitting genetic abnormalities. This may include chromosomal analysis (e.g., Klinefelter syndrome) or gene mutation testing. Combined with preimplantation genetic testing (PGT), couples can make informed choices to safeguard their future child’s health.

How does ICSI affect embryo quality?

ICSI has not been shown to negatively affect embryo quality. On the contrary, in cases of male infertility, it offers a controlled fertilization environment that increases the chances of developing viable embryos. When high-quality eggs and well-selected sperm are used, the resulting embryos develop comparably to those created via conventional IVF. At FertUlity, we implement optimized embryo culture protocols to ensure top-tier embryological outcomes.

What happens if fertilization fails after ICSI?

Complete fertilization failure after ICSI is rare, occurring in fewer than 5% of cases. However, if it does happen, the cycle is usually canceled, and the medical team reviews all parameters. Partial failure, where only a few eggs are fertilized, is more common. At FertUlity, we place great emphasis on identifying the causes and making adjustments in future attempts—such as modifying stimulation protocols, improving sperm processing, or conducting further diagnostic testing.

Are there age restrictions for ICSI treatment?

ICSI as a technique has no strict age limits, but a woman’s age significantly influences success rates. After age 40, both egg quality and quantity typically decline, directly impacting implantation and pregnancy outcomes. Greek law (as of 2022) permits IVF treatment up to age 54 under specific conditions. At FertUlity, we carefully assess each woman’s medical and hormonal profile to provide realistic expectations and responsible guidance before treatment begins.

Can ICSI be performed with frozen eggs or sperm?

Yes, ICSI is fully compatible with the use of frozen eggs or sperm. In fact, it is often the preferred method—especially for previously frozen eggs. Cryopreservation can harden the outer shell of the egg, making natural sperm penetration difficult. With ICSI, the embryologist directly injects the sperm into the egg, bypassing this barrier. At FertUlity, we use high-precision protocols for fertilizing frozen gametes to ensure optimal success conditions.

How long does the ICSI process take?

ICSI is part of a complete IVF cycle that typically lasts 4 to 6 weeks. Ovarian stimulation takes around 10–12 days, followed by egg retrieval, sperm injection (ICSI), and embryo culture for 3–5 days. Embryo transfer is then performed. The ICSI procedure itself—injecting sperm into eggs—takes a few hours in the lab, but medical supervision and support continue throughout the entire cycle.

What is the cost of ICSI?

At FertUlity, we believe access to effective treatment should not be limited by cost. That’s why ICSI is included in all our IVF protocols at no additional charge. We offer fully transparent treatment plans so couples can focus on care and hope, not expenses. The total cost may vary depending on the need for genetic testing (PGT) or additional evaluations. Our team is always available to provide personalized financial guidance.

Are babies born via IVF and ICSI healthy?

Babies conceived through ICSI are generally just as healthy as those conceived naturally. Some studies suggest a slightly higher chance of preterm birth or low birth weight, but the vast majority of ICSI-conceived children are completely healthy. At FertUlity, we apply rigorous scientific protocols and personalized monitoring to provide parents with confidence and high-quality care from conception to birth.

Does ICSI increase the risk of autism?

The potential link between ICSI and autism has been explored in several studies. While some findings show a slightly higher prevalence of autism spectrum disorders among children conceived via assisted reproductive technologies, the evidence is not conclusive. Many other factors—such as parental age, genetics, and underlying health conditions—play a more significant role. At FertUlity, we address parents’ concerns with scientific integrity, offering evidence-based guidance at every step.

Can ICSI cause chromosomal abnormalities?

When performed with proper criteria and scientific accuracy, ICSI does not significantly increase the risk of chromosomal abnormalities. Since the technique bypasses natural sperm selection, there’s a theoretical chance of using sperm with hidden genetic defects. That’s why at FertUlity, we thoroughly assess sperm quality prior to use and recommend preimplantation genetic testing (PGT) when indicated. This ensures that only healthy embryos are transferred, offering maximum safety for the couple.

Can ICSI damage the embryos?

ICSI is a highly delicate and precise technique, but when performed by skilled embryologists—like those at FertUlity—the risk of damage is minimal. There’s a small theoretical possibility of injuring the egg during sperm injection, but this is rare. Our embryologists use cutting-edge micromanipulation tools in a meticulously controlled environment to protect each egg and embryo, ensuring optimal development conditions.

Our Doctors

Their knowledge. Their care. Your confidence.

Dr. Maria Oikonomou Obstetrician – Gynecologist

Specialisation: Infertility & Gynaecological Endocrinology
“My goal is for every woman to feel that she has a voice and support on her journey to motherhood.”
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Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

Specialisation: IVF & Reproductive Endocrinology
“Science is the foundation. Trust is the key.”
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The First Step Starts Now

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Why choose FertUlity?

Because here, IVF is not just a medical procedure. It is a personal matter.

At FertUlity, we believe that every couple deserves to feel secure, respected and hopeful. We combine expertise in reproductive medicine, modern IVF techniques and a human approach that makes all the difference.

Our treating physicians, Dr. Maria Oikonomou and Dr. Makis Papadopoulos, are officially specialised in infertility and gynaecological endocrinology, offering personalised protocols for each case. We collaborate with leading units, such as the Institute of Life and the IAMA Clinic, utilising cutting-edge technology, with transparent prices, high success rates and a holistic approach.

We collaborate with leading units, such as the Institute of Life and the IAMA Clinic, utilising cutting-edge technology, with transparent prices, high success rates and holistic support throughout your journey.

FertUlity means reliability, expertise and human interest. Because life begins with the right choice.

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