ICSI - Intra Cytoplasmic Sperm Injection

In practice

As in IVF, ICSI involves stimulating the maturation of several follicles in the woman, collecting the oocytes (eggs) via transvaginal aspiration, and then placing them in a culture medium.

However, contrary to classic IVF, a single sperm (from an ejaculation or from a sample taken from a testicle or the epididymis) is then directly injected into the cytoplasm of the oocyte.

After the embryos have been cultured for 2 to 5 days, a limited number of embryos are returned to the uterus, in accordance with legal provisions.

ICSI may be indicated for a very low sperm count (oligoasthenoteratozoospermia, and in cases of unexplained infertility).

What are the risks?

ICSI carries the same risks as IVF:

- In around 5% of cases, ovarian hyperstimulation can manifest itself through abdomen bloating (which fills with fluid). In rare cases, this can require a hospitalisation of a few days, with an intra-vaginal puncture to drain the fluid, and an intravenous drip to restore the hydromineral balance.

- In fewer than 2/1000 cases of oocytes retrieval, it can reawaken a previous infection of the tubes, requiring antibiotics and a hospitalisation of several days.

- In exceptional cases (1/1000) it can cause delayed bleeding where several follicles have been retrieved. Sometimes this may require a laparoscopy to remove the blood.

The highest risk used to be twin pregnancies (20% of pregnancies until 2003) and triplet pregnancies (2%).

With the current facilities available (transfer of a single embryo in young women), these risks have reduced to approximately 10% and 0.2% respectively, which is more or less equal to the risk of spontaneous multiple pregnancy in cases where MAR techniques have not been used.