Intracytoplasmic sperm injection (ICSI) is a specialised method of artificial insemination that opens up new possibilities for couples with an unfulfilled desire for children. With ICSI, a selected sperm cell is injected directly into an egg in the laboratory. ICSI is often considered a particularly appropriate treatment method in cases of serious male fertility disorders, such as reduced sperm quality.
Overview of ICSI
Intracytoplasmic sperm injection, where a single sperm is inserted directly into the extracted egg, is one of the most advanced methods of assisted reproduction technology (ART). This form of artificial insemination takes place in the laboratory and is most commonly carried out when the man’s fertility is impaired.
ICSI vs. IVF
With standard in vitro fertilisation (IVF), tens of thousands of sperm cells are put in contact with an egg in vitro. If the man’s sperm quality is not high enough or not enough sperm cells have been produced, standard IVF does not stand a good chance of being successful. This is not the case with intracytoplasmic sperm injection (ICSI), however: the advantage of this treatment method is that only a few sperm cells are needed. Experienced biologists deliberately inseminate the egg with a selected, fast and optically flawless sperm.
Treatment goal
The main goal of ICSI treatment is to enable insemination even under difficult conditions and to increase the chances of a successful pregnancy. The ICSI is particularly suitable for couples where one of the following conditions is met:
- Severely impaired sperm quality (e.g. low number, low mobility, abnormal shape).
- Previous failed inseminations with conventional IVF.
- Presence of antibodies in semen that impair sperm motility.
- Use of frozen or surgically obtained semen (e.g. after vasectomy or testicular disease).
Requirements for ICSI treatment
In order to be able to carry out ICSI treatment medically safely and in accordance with the legal requirements in Switzerland, certain conditions must be met:
- Basic examinations are required, including a hormone analyses of the woman, ultrasound examinations and a semen analysis of the man.
- The age of the women should ideally not be over 43 to 44 years, while the maximum age for the man should be 63 to 65 years.
- Both partners must have tested negative for HIV, hepatitis B/C and syphilis.
- It is necessary for the women to have immunity against rubella and chickenpox.
- It must be a stable partnership (marriage is not mandatory).
ICSI procedure
Phase 1: Hormonal stimulation of the ovaries
After a detailed consultation with a specialist in reproductive medicine, the doctor checks the quality of the man’s sperm and carries out a hormone treatment for the woman. This prevents premature ovulation and encourages the ovaries to mature several follicles at the same time.
Phase 2: Egg removal
During regular check-ups over the next two weeks, the doctor checks to see how far the eggs have matured and whether ovulation can be triggered. When this time comes, the doctor removes the eggs from the ovaries. Egg collection is carried out on an outpatient basis and the clinic can be left on the same day.
Phase 3: Sperm collection and preparation
The man delivers a semen sample the same day. This is processed using various methods such as physiological sperm selection in order to select the most suitable sperm.
Phase 4: Injection of the sperm cell
Next is the actual intracytoplasmic sperm injection (ICSI): the sperm cell is transferred directly into the egg’s cellular fluid. The eggs are then developed into embryos for three to five days and observed.
Phase 5: Embryo transfer
The attending specialist then transfers one or two embryos back to the woman’s uterus (embryo transfer).
Phase 6: Cryopreservation
If further embryos have developed well, they are frozen in liquid nitrogen if desired and stored in the laboratory. They will be available for any further treatments in the future.
In certain situations, special forms are used instead of the normal ICSI treatment, such as pICSI (physiological ICSI, in which optimal sperms present themselves), IMSI (particularly detailed analysis of sperm under a special microscope) or co-treatment with calcium ionophore.
Preparation and precautions
Thorough preparation is crucial for the success of ICSI therapy. This includes a series of examinations: the hormone status of the woman is checked to assess the ovarian reserve and the course of the cycle, while a sperm analysis is performed to provide information on the number, motility and shape of the sperm. Blood tests help to detect infections, genetic abnormalities or health risks at an early stage. In addition, the uterus and ovaries are examined using an ultrasound.
In addition to these medical preparations, having a healthy lifestyle plays an important role. Avoiding nicotine and alcohol and maintaining a balanced diet can support fertility. It also helps to actively reduce stress – whether through targeted relaxation techniques or professional advice.
Aftercare and recovery
Patience is required after ICSI therapy. Regular blood tests and ultrasound examinations are used to monitor the development of the embryo, during which the patient should rest physically. Around two weeks after the embryo transfer, a blood test will determine whether the treatment was successful. After about four weeks, the first ultrasound is usually performed to check whether the amniotic sac has developed in the uterus and whether the embryo’s heartbeat is visible.
If the treatment is unsuccessful, it is possible to carry out further attempts with frozen embryos. In this emotionally challenging time, psychological support can offer valuable assistance in helping you deal with setbacks and gain new courage.
Potential complications
ICSI is an established and safe procedure, but in rare cases complications can occur:
- Ovarian hyperstimulation syndrome (OHSS): an overstimulation of the ovaries by hormones that can cause pain or fluid retention.
- Multiple pregnancies: the transfer of more than one embryo can lead to multiple births.
- Ectopic pregnancy: as with natural conception, in rare cases the embryo can implant itself in the fallopian tube.
- Infections: in very rare cases, infections may occur after egg collection.
- Psychological stress: the emotional pressure that can arise during treatment should not be underestimated and deserves special consideration.
Prospects of success
The chances of ICSI success depend largely on the age of the woman and her individual ovarian reserve. From the age of 35, the chances of success drop significantly and halve by the age of 40.
During the treatment planning phase, various tests are carried out that allow a relatively accurate assessment of the chances of success. Your attending doctor will provide you with detailed information on how realistic it is to fulfil your wish for children in your individual case.
Legal basis
In Switzerland, artificial insemination is regulated by the Reproductive Medicine Act (RMA), which lays down clear ethical and legal frameworks. Treatment is only available to couples who are either married or in a stable relationship. Up to three embryos may be created and transferred per treatment cycle. Under certain conditions, such as an increased risk of serious hereditary diseases or to avoid chromosomal abnormalities, preimplantation genetic diagnosis (PID) is also permitted. However, the selection of embryos according to sex or external characteristics is prohibited by law. Embryos can be cryopreserved and stored for up to ten years for use in subsequent treatment cycles. Procedures such as egg donation and surrogacy are not permitted in Switzerland.