The world of assisted reproductive technology is rapidly evolving and the range of different options and methodologies available might seem overwhelming for people embarking on their family-building journey. What's heartening to know however, is that all these different options have made the process of achieving parenthood possible for many individuals and families who otherwise would not have been able to conceive.
IVF is seemingly the most commonly used terminology in TTC circles however, there are multitudes of other techniques that can be administered, depending on each unique case, for the purpose of completing a successful pregnancy.
ICSI is one such example. Intracytoplasmic Sperm Injection (ICSI) in fact, is a form of IVF where the sperm is directly injected into the egg as opposed to traditional IVF where the sperm is introduced to fertilize the egg in a petri dish. Some medical experts advise all IVF procedures should employ ICSI in the sense that it gives more control over the sperm's ability to penetrate and fertilize the egg.
Why is ICSI done?
Your fertility team might decided on pursuing this option if you or your partner cannot conceive due to male factor infertility. Male factor infertility can be a problem because of a number of reasons such as low sperm count, abnormal sperm shape and low sperm motility. However, male fertility is not always the reason your Reproductive Endocrinologist would suggest ICSI to you; there are a number of other instances that might warrant this option for your fertility treatment, such as:
Repeatedly failed IVF cycles
When using frozen sperm and the thawed sperm still appear to be dormant
When using frozen oocytes and the exterior of the eggs seems slightly hardened
Surgical retrieval of sperm from semen
What is the outlook on success rates?
There's some disagreement in fertility circles regarding the use cases and success rates of ICSI. As discussed above, a lot of RE's are of the view that supplementing your IVF procedure with ICSI guarantees that you can steer clear of fertilization failures. As far as fertilization is concerned, that is true to a certain degree since there's about a 90% chance of successful fertilization through carefully performed ICSI. How that impacts the success of an IVF cycle though, is still largely debatable since that statistic hinges on a wide range of different factors including maternal age, egg quality and sperm quality. So, even after fertilization occurs successfully, the guarantee that it would lead to a live birth is still dependent on a host of other variables.
What will it cost me?
Since ICSI is done in a lab as part of your regular IVF cycle, it might cost you around $1500-$2000 on top of your routine treatment, as estimated by the American Society for Reproductive Medicine (ASRM).
How safe is ICSI?
As with any IVF procedure, there are certain foreseeable risks involved that just cannot be ruled out. However, with ICSI there's a very slight increase in some of these in the form of certain birth defects and genetic impairments. Again, since the likelihood of these disorders is extremely rare and not backed by any conclusive evidence, it should not be considered as a major drawback to the treatment. In fact, a natural pregnancy also carries a certain small degree of risk with it so that apprehension should not hinder you from researching into this treatment option. The most commonly feared birth defect associated with ICSI is that of passing the male infertility down to a male child. That too however is caused by the male factor infertility inherent in the sperm and not due to the ICSI technique specifically, though it is reason enough for many medical experts to rule out the use of ICSI preemptively for all IVF procedures.
All in all, ICSI is a fairly safe choice if you want to maximize your chances of egg fertilization and/or you're dealing with male factor infertility. Regardless of your unique circumstances, it is imperative that you consult a fertility expert of your preference and discuss all possible options available to you depending on your treatment trajectory.