What to Know Before Undergoing ICSI

ICSI is a form of IVF in which a single sperm is injected directly into an egg rather than left to fertilize it in a dish. It was developed for male factor infertility, and that is where its benefit is clearest: a very low sperm count, poor motility, abnormal morphology, or sperm retrieved surgically. Where there is no male factor, the evidence does not support using it routinely. An American Society for Reproductive Medicine committee opinion concludes that in the absence of male factor infertility or previous fertilization failure, routine ICSI does not improve live birth rates. It also costs more than conventional IVF, so it is worth understanding which situation applies to you.

What is ICSI?

In conventional IVF, eggs and prepared sperm are placed together and fertilization is left to occur. In ICSI, an embryologist selects one sperm and injects it directly into each mature egg under a microscope. Everything else about the cycle, the stimulation, the egg retrieval, the culture of the embryos and the embryo transfer, is the same.

Fertilized eggs are cultured in the laboratory and monitored over several days as they develop. Suitable embryos are then selected for transfer, and any others may be frozen.

When is ICSI recommended?

The established indications are male factor:

• A very low sperm count.
• Poor sperm motility or a high proportion of abnormally formed sperm.
• Sperm retrieved surgically, through TESA, PESA or TESE, where numbers are too small for conventional insemination.
• Frozen sperm where the post-thaw quality is limited.
• Previous fertilization failure in a conventional IVF cycle.

Beyond these, ICSI is sometimes offered for unexplained infertility, older maternal age or low egg numbers. This is where the American Society for Reproductive Medicine committee opinion matters: it finds that routine ICSI in the absence of male factor or prior fertilization failure does not improve live birth rates. If ICSI is proposed and there is no male factor in your case, ask specifically what it is expected to achieve and what it adds to the cost.

What are the success rates?

Success depends far more on the woman's age and on the underlying diagnosis than on whether ICSI or conventional insemination is used. Be careful with any single headline percentage. A meaningful figure has to state the year, the number of cycles, the age group, and whether it is measured per cycle started or per embryo transfer, and whether it means clinical pregnancy or live birth. Those choices move the number substantially.

Ask us for our rates on that basis, for your own age band, so you can compare like with like. Our IVF success rates page covers how to read these figures.

How should you prepare for ICSI?

Preparation matters mainly through sperm and egg quality, and it works over months rather than weeks, since a cycle of sperm production takes roughly two to three months.

• Stop smoking, both partners, and avoid secondhand smoke. See the ASRM fact sheet on smoking and infertility.
• Reduce alcohol and caffeine, in line with ASRM guidance on optimizing natural fertility.
• Avoid sustained heat to the testes, such as hot baths and saunas, in the months before sperm collection.
• Follow the abstinence interval your clinic specifies before providing a sample. The WHO laboratory manual specifies 2 to 7 days for semen analysis.
• Take prescribed medication exactly as instructed, and check any other medication or supplement with your doctor first.

Our article on preparing for egg retrieval and sperm collection covers the practical instructions for the day itself.

What are the trade-offs?

Where there is a male factor, ICSI addresses a problem that conventional insemination cannot, and that is a clear benefit. Against that, it costs more than conventional IVF, and it is an additional laboratory manipulation of the egg. Where no male factor exists, you are paying for both without the evidence of a corresponding gain in live birth rate.

We at Millennium IVF Clinic will go through whether ICSI applies in your case and why. You can arrange a consultation with our team.

Frequently asked questions

Is ICSI better than IVF?

Not in general. It is better where there is a male factor or previous fertilization failure. Where there is not, the ASRM committee opinion finds routine ICSI does not improve live birth rates.

Does ICSI guarantee fertilization?

No. Injecting the sperm bypasses the barrier to fertilization but does not guarantee that the egg will fertilize or that the embryo will develop.

Is ICSI more expensive?

Yes, it adds to the cost of an IVF cycle. Our costs page sets out our package pricing, which starts from around 250,000 to 350,000 THB per cycle depending on the treatment plan and what is included. Ask us for the ICSI difference in writing so you can weigh it against the reason it is being recommended.

How long can eggs, sperm and embryos be stored?

Storage in Thailand is governed by the Protection of a Child Born by Medically Assisted Reproductive Technology Act B.E. 2558 (2015), which delegates the storage period to the Medical Council of Thailand rather than fixing one in the Act. Ask us what period applies and what you need to sign. Note that section 41 prohibits importing or exporting sperm, eggs or embryos, so material stored here cannot be moved abroad.