A Complete Guide to an ICSI Procedure

What is ICSI?

Arizona Center for Reproductive Endocrinology and Infertility was one of the first clinics in Arizona to achieve pregnancy through an ICSI procedure. This monumental achievement was possible through the support of grant money from the University of Arizona, which helped our team buy the equipment and perform the ICSI procedure, which was innovative and experimental at the time (1995). Dr. Gelety is a well-known male infertility doctor at Arizona Center for Reproductive Endocrinology and Infertility who addressed the issue of male infertility in his recent press appearance. He maintains that being healthy and proactive are two main factors in mitigating fertility issues. He also states that infertility can happen on either side of the male-female equation, so it is a good idea for both to get checked for infertility.

So what is ICSI? The ICSI procedure is an advanced assisted reproductive technology (ART) technique used in fertility treatments to help couples conceive a child. ICSI stands for Intracytoplasmic Sperm Injection, and it is advantageous in cases of male infertility or when other fertility treatments have not been successful.

During the ICSI procedure, a single sperm is selected and directly injected into the cytoplasm of an egg to facilitate fertilization. The process involves several steps. First, the eggs get retrieved from the woman’s ovaries through a minor surgical procedure called follicular aspiration. Then, the eggs get examined to identify which ones are mature and healthy for the injection procedure.

Next, a single sperm is selected, usually obtained from the male partner’s semen sample or, in some cases, extracted surgically from the testicles or epididymis. The selected sperm is immobilized and carefully injected into the cytoplasm of the healthy egg using a fine needle called a micropipette. This injection bypasses the need for natural sperm penetration, increasing the chances of fertilization even if the sperm has poor motility or morphology.

After the injection, the fertilized eggs, now called embryos, are monitored to ensure proper development. Usually, multiple embryos get created to increase the chances of successful implantation. The resulting embryos are typically grown in a laboratory for a few days until they reach a suitable stage for transfer.

Finally, one or more healthy embryos get transferred into the woman’s uterus through a catheter, where they may implant and achieve a successful pregnancy. Any remaining viable embryos can be cryopreserved (frozen) for future use if desired.

The ICSI procedure has revolutionized the treatment of male infertility, allowing couples with severe sperm-related issues to achieve successful fertilization and pregnancy. It is commonly used with in-vitro fertilization (IVF) and has significantly improved the chances of conception for couples facing male-factor infertility.

It’s important to note that the ICSI procedure, like any medical procedure, has certain risks and considerations. The method may not always result in successful fertilization or pregnancy. There is also a minimal risk of damage to the egg during the injection process and the possibility of passing on genetic abnormalities.

A History of the ICSI Procedure

The history of ICSI can be traced back to the early 1990s when a breakthrough was achieved in Belgium. In 1992, Dr. Gianpiero D. Palermo and his team at the Vrije Universiteit Brussel accomplished the first pregnancy through ICSI. Their groundbreaking work was published in a peer-reviewed article titled “Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte” in The Lancet. This seminal study described the technique of a male infertility doctor injecting a single sperm directly into the cytoplasm of an egg, overcoming severe male infertility.

This pioneering achievement opened up new possibilities in the field of reproductive medicine. ICSI quickly gained recognition for its high success rates, allowing couples previously considered infertile to achieve pregnancies with the help of a male infertility doctor. The technique rapidly evolved with the development of micromanipulation tools and methods. Initially, the procedure involved manually controlling micromanipulators to inject sperm, but advancements led to introducing of robotic-assisted systems, enhancing precision and accuracy.

As the applications of ICSI expanded, it began to be used not only for male-factor infertility but also for other conditions such as unexplained infertility, previous fertilization failure, and cases where conventional IVF techniques were unsuccessful. The continuous research and improvements in ICSI have significantly contributed to its widespread adoption as a standard procedure in ART while putting Arizona Center for Reproductive Endocrinology and Infertility at the forefront of male infertility progress.

To delve deeper into the history of ICSI, the peer-reviewed article “Paternal effects acting during the first cell cycle of human preimplantation development after ICSI” by Tesarik et al., published in Human Reproduction (1994), provides valuable insights. This study explores the paternal effects on early human development following ICSI and sheds light on the impact of the procedure during the critical first cell cycle of preimplantation development.

These peer-reviewed resources offer comprehensive information on the history, breakthroughs, and advancements in the ICSI procedure, highlighting its impact in addressing male infertility and helping couples achieve successful pregnancies.

When Does Having an ICSI Make Sense?

Arizona Center for Reproductive Endocrinology and Infertility believes that when considering the suitability of Intracytoplasmic Sperm Injection (ICSI), it becomes relevant to examine the sperm count in males. An average sperm count typically ranges from 20 million to 200 million per milliliter. In cases where the sperm count falls between 5 million and 20 million per milliliter, Dr. Gelety, a renowned expert in the field, is likely to recommend Intrauterine Insemination (IUI) as the initial approach. However, when the sperm count drops below 2 million per milliliter, the chances of success with IUI statistically diminish. This situation calls for an alternative solution, where ICSI often comes into play. ICSI is highly recommended when the male’s sperm count falls below 2 million per milliliter, as it offers the best chance of fertilizing an egg using the available healthy sperm.

In cases where a male has undergone a vasectomy, Intracytoplasmic Sperm Injection (ICSI) emerges as a preferred alternative to a vasectomy reversal. ICSI can often offer higher success rates than vasectomy reversals while being more cost-effective. Rather than attempting to restore the normal flow of sperm by reversing the vasectomy, ICSI allows for the direct injection of sperm into the egg, bypassing the need for a functioning vas deferens. This workaround makes ICSI an attractive option for couples seeking to conceive after a vasectomy, providing a potentially more efficient and economical pathway to achieve pregnancy.

In cases where a patient is diagnosed with Congenital Absence of a Vas Deferens, which is often associated with conditions like Cystic Fibrosis, the ducts responsible for carrying sperm from the testicles into the ejaculate are either missing or ineffective. As a result, no sperm is present in the semen, leading to fertility challenges. In such situations, using Intracytoplasmic Sperm Injection (ICSI) becomes a viable option. ICSI involves retrieving healthy sperm directly from the testicles or epididymis and injecting it directly into the egg, bypassing the need for the vas deferens. This procedure allows for the fertilization of the egg despite the absence or dysfunction of the vas deferens, offering a potential pathway for individuals with congenital absence of vas deferens to achieve successful conception.

Facing infertility as a couple can be an incredibly challenging and emotionally draining experience, particularly when uncertainty lingers regarding which partner may be contributing to the difficulty. In the past, the road to understanding the underlying causes of infertility involved independent testing of sperm and egg, which added to the already overwhelming journey and cost considerations. However, with the advent of Intracytoplasmic Sperm Injection (ICSI), we now have a more compassionate approach. ICSI allows Arizona Center for Reproductive Endocrinology and Infertility to bypass much of the extensive testing that used to be required. By directly injecting a single sperm into the egg, we can increase the likelihood of successful fertilization while offering a more affordable option. Through ICSI, we aim to ease the burden of uncertainty and provide a compassionate pathway for couples to embrace hope and the potential for fulfilling their dreams of starting a family.

What Should a Patient Expect with Our Clinic?

At our clinic, when patients undergo in vitro fertilization (IVF), we kindly request their consent for Intracytoplasmic Sperm Injection (ICSI) if fertilization does not occur naturally in the petri dish. We understand that time is of the essence in achieving successful fertilization, as the egg must get fertilized within the critical first 24 hours. Therefore, incorporating ICSI into our protocol ensures we provide you with the best opportunity to achieve pregnancy if standard IVF methods do not yield the desired results. We aim to optimize your chances of success while maintaining a patient-centered approach throughout your fertility journey.

While some male infertility doctors or clinics may recommend routine Intracytoplasmic Sperm Injection (ICSI) procedures to enhance the chances of fertilization, Dr. Gelety takes a different stance on this matter. He believes that such an approach is only sometimes reasonable or effective. Routine ICSI can significantly increase costs and pose logistical challenges due to the requirement of collecting eggs and sperm separately for the procedure. Moreover, it is essential to note that this approach does not necessarily improve pregnancy success rates. Dr. Gelety’s perspective prioritizes the patient’s best interests by carefully assessing the need for ICSI on a case-by-case basis. This in-depth consideration ensures that the procedure is recommended when necessary and can significantly enhance the chances of successful fertilization. At Arizona Center for Reproductive Endocrinology and Infertility, the cost for an ICSI is $1,200, reflecting our commitment to providing accessible and affordable male infertility doctor care without compromising individualized treatment decisions.

When considering success rates, a standard IVF procedure is generally associated with a 70% success rate. However, when Intracytoplasmic Sperm Injection (ICSI) gets combined with IVF, the effectiveness can increase to as high as 80%. If a standard IVF attempt does not lead to successful fertilization, incorporating ICSI into the procedure becomes the next logical step. As long as the egg and sperm are healthy, the likelihood of fertilization is significantly improved. Subsequently, the quality and health of the embryo become crucial factors as the female begins the pregnancy journey. By incorporating ICSI into the treatment plan, we aim to optimize the chances of successful fertilization and ultimately support the development of a healthy pregnancy.


Intracytoplasmic Sperm Injection (ICSI) has emerged as a groundbreaking technique in assisted reproductive technology (ART), offering new hope to couples facing infertility challenges. With a history rooted in the early 1990s, ICSI has revolutionized the treatment of male infertility and expanded its applications to address various fertility conditions. Peer-reviewed studies have documented the success of ICSI in achieving pregnancies, providing valuable insights into its efficacy and impact on early human development. Dr. Gelety and Arizona Center for Reproductive Endocrinology and Infertility believe ICSI offers a compassionate and effective solution for couples struggling with male infertility. By carefully assessing the need for ICSI on a case-by-case basis, we can optimize the chances of fertilization, with success rates potentially exceeding those of standard IVF. Furthermore, incorporating ICSI into the treatment plan can offer couples a more affordable and logistically feasible option. Ultimately, ICSI aims to support couples on their journey to parenthood by increasing the likelihood of successful fertilization and the development of healthy pregnancies.

If you’d like to get more information on the ICSI procedure or start your fertility journey with Arizona Center for Reproductive Endocrinology and Infertility, you can contact us online. You can also stay up-to-date on the latest clinic news by following us on Facebook.

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