Fertulity IVF
Fertulity IVF

Intracytoplasmic Sperm Injection (ICSI)

What is Intracytoplasmic Sperm Injection (ICSI)?

Intracytoplasmic Sperm Injection (ICSI) is an advanced assisted reproductive technology (ART) used in cases of severe male infertility or fertilization failure with conventional IVF and SBHSE, meaning when traditional in vitro fertilization (IVF) has not been successful.

At FertUlity, we use the ICSI technique when sperm cannot naturally penetrate the egg. This method allows the direct injection of a selected sperm cell into the cytoplasm of the egg with micromanipulation precision. By doing so, barriers such as low sperm motility or abnormal sperm morphology can be bypassed, significantly increasing the chances of successful fertilization.

ICSI differs from conventional IVF, as it does not rely on the natural interaction between sperm and egg. Instead, it is a laboratory-controlled procedure performed by an embryologist, ensuring maximum precision and high fertilization success rates according to the strict protocols followed at FertUlity.

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.

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.

When Is ICSI Used?

Intracytoplasmic Sperm Injection (ICSI) is not always the first-line option in fertility treatment. However, there are specific situations where it offers significant advantages. At FertUlity, ICSI is applied with precision and scientific evidence in the following cases:

Severe Male Infertility

When conditions such as oligospermia, asthenozoospermia, or teratozoospermia are present, or when sperm cannot naturally penetrate the egg.

Absence of Sperm in Ejaculate (Azoospermia)

In cases where sperm is retrieved directly from the testes or epididymis through procedures such as TESA, TESE, Micro-TESE, or PESA.

Previous IVF fertilization failure

When previous IVF cycles did not result in successful fertilization, even when laboratory tests appear normal.

Use of frozen eggs

When cryopreserved eggs are thawed for fertilization, ICSI is recommended to maximize fertilization success rates.

Use of Frozen Sperm

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

Use of donor sperm or donor eggs

To ensure optimal use of the available genetic material in donor-assisted fertility treatments.

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 procedure (Intracytoplasmic Sperm Injection) follows a carefully controlled and targeted medical approach designed to ensure maximum safety and the highest possible chance of success. Below are the main stages of the process.

Success Rates & Effectiveness

Intracytoplasmic Sperm Injection (ICSI) is one of the most effective techniques used in assisted reproductive technology, particularly in cases of male infertility. At FertUlity, fertilization rates with ICSI typically range between 70% and 85%, even when sperm shows low motility, abnormal morphology, or has been surgically retrieved through procedures such as TESE, TESA, Micro-TESE, or PESA.

This high fertilization rate is mainly due to the direct injection of a selected sperm cell into the egg, bypassing the natural barriers that may prevent fertilization. By contrast, in conventional IVF, fertilization rates usually range between 50% and 70%, and may decrease significantly when sperm quality issues are present.

However, it is important to note that the overall pregnancy rate does not depend solely on the fertilization technique, but also on factors such as embryo quality, the woman’s age, and the overall reproductive health of the couple.

For this reason, at FertUlity, we apply personalized fertility treatment strategies to maximize the chances of achieving a successful pregnancy.

Preparing for ICSI

The success of Intracytoplasmic Sperm Injection (ICSI) begins with proper and targeted preparation. At FertUlity, we place particular emphasis on the early stages of the process, creating a personalized fertility treatment plan for each couple.
Step 1

Medical Evaluation and Detailed Fertility Assessment

The first step is a consultation with our medical team to collect a complete medical history and identify factors that may affect fertility.

The female partner undergoes ovarian reserve testing, including AMH, FSH, and Estradiol levels, while the male partner undergoes a semen analysis to assess sperm count, motility, and morphology.

Additional tests may also be recommended, particularly in cases of severe male infertility, such as sperm DNA fragmentation testing or genetic screening, to ensure a thorough evaluation before starting treatment.
A fertility doctor in a lab coat reviews patient documents, reflecting the careful planning behind successful IVF procedures.
Step 2

Counseling and Informed Consent

Preparing for ICSI treatment involves not only medical preparation but also psychological support. At FertUlity, we provide counseling sessions to help couples understand all aspects of the process, including emotional, physical, and financial considerations.

Our fertility specialists explain each stage of the treatment clearly, answer all questions, and guide patients through the process of signing the required informed consent forms.
A fertility specialist consults a couple while holding a female symbol, illustrating IVF planning and patient education.
Step 3

Lifestyle Optimization and Physical Readiness

Before starting the ICSI cycle, certain lifestyle adjustments are recommended to improve success rates. These may include quitting smoking, reducing alcohol consumption, adopting a balanced diet, regular physical activity, and stress management.

In some cases, nutritional supplements such as folic acid, vitamin E, or vitamin C may be recommended to help improve egg quality and sperm health, supporting the overall success of the fertility treatment.
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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 Micromanipulation Fertilization Methods

IMSI Method – Intracytoplasmic Morphologically Selected Sperm Injection

The IMSI method (Intracytoplasmic Morphologically Selected Sperm Injection) is an advanced sperm selection technique used in IVF treatment to maximize the chances of successful fertilization.

At FertUlity, IMSI is used when sperm morphology or sperm quality is suboptimal. This technique utilizes a high-magnification microscope, allowing embryologists to identify sperm cells with optimal morphological characteristics. By selecting the most suitable sperm for intracytoplasmic injection, IMSI may help reduce the risk of miscarriage and improve fertilization and implantation outcomes.

Although scientific evidence is still evolving, IMSI is considered a high-precision personalized approach, particularly recommended in cases of repeated IVF failures or implantation difficulties, enhancing quality control throughout the treatment process.

PICSI Method – Physiological Intracytoplasmic Sperm Injection

The PICSI method (Physiological Intracytoplasmic Sperm Injection) is an advanced ICSI-based sperm selection technique that improves the selection of the most suitable sperm cell based not only on morphology and motility, but also on its functional maturity.

At FertUlity, PICSI is recommended when the HBA test (Hyaluronan Binding Assay) shows low binding to hyaluronic acid, or when there is a high DNA fragmentation index (DFI) — factors that may negatively affect fertilization and embryo quality.

During the procedure, only mature and functionally competent sperm cells that naturally bind to hyaluronic acid, as occurs in natural fertilization, are selected. This technique provides a personalized and advanced fertility treatment option, improving the chances of successful fertilization and embryo development.
A smiling father holds his swaddled newborn, capturing the emotional reward and bond formed through IVF family building.

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 A single sperm cell is injected into the egg without advanced sperm selection techniques. 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 Cases of low sperm count, reduced sperm motility, or abnormal sperm morphology. Repeated implantation failures / poor morphology Low HBA, high DFI, IVF failures

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 2 to 3 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. 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

In an era where fertility requires knowledge, care, and substantial guidance, FertUlity is not an impersonal clinic. It is two people who look you in the eye and accompany you step by step on the journey you dream of.

Dr. Maria Oikonomou Obstetrician – Gynecologist

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Dr. Chrysostomos (Makis) Papadopoulos Obstetrician – Gynecologist, MD, PhDc, MIC I

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