Author: John David Gordon MD
For those of you following Southeastern Fertility on Facebook, you may have seen the DrG and Lynda show last week during which Lynda educated me on the correct East Tennessee pronunciation of certain words like “fur” and “hollow.” In return, I “learned her how to Tawk Boston” by having her pronounce “b-e-d-d-a-h” like a native Bostonian. Once the war of the accents had ended Lynda returned to work and I spent some time discussing Intracytoplasmic Sperm Injection or ICSI (ick-zee).
The most common indication for ICSI is male factor infertility associated with an abnormal semen analysis. Therefore, men with unproven fertility and a semen analysis demonstrating an abnormal sperm count, motility, or morphology are appropriate candidates for IVF with ICSI to improve the chances of successful fertilization. However, there can be differences of opinion between REI physicians and embryologists as to how abnormal a semen analysis needs to be for ICSI to be recommended over traditional IVF (putting 50,000 to 100,000 sperm in a droplet of fluid with each egg).
Some men may have a blockage in their reproductive tract that may keep sperm from getting out, perhaps as a result of a surgical procedure like a vasectomy or because of certain congenital abnormalities. In these and other cases, a specially trained urologist may retrieve sperm directly from the testicles or epididymis. Surgically retrieved sperm requires IVF with ICSI for fertilization, because typically such procedures rarely yield a sufficient number of sperm for IUI or standard IVF. Even though the sperm looks adequate, non-ejaculated sperm has not undergone the final maturation process and therefore ICSI should be utilized to fertilize eggs using any surgically retrieved sperm. ICSI may also be used for cases where traditional IVF has not resulted in fertilization (sometimes referred to as “fertilization failure”), regardless of whether the semen analysis is normal. ICSI is also used in any case with previously cryopreserved oocytes or in-vitro matured oocytes.