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20 years ago, when we encountered the male partner with severe poor sperm quality, the options were sperm donation or hoping for miracle to occur. Fortunately, now we have ICSI to help these couples with severe low sperm quality to have baby of their own. ICSI is a newly developed technique which has greatly improved the management of male infertility due to severe oligozoospermia (low sperm count) and asthenozoospermia (low motility). This technique can treat those men who produce extreme poor quality sperm. In ICSI, we need a few sperm and one sperm is injected directly into one egg using a fine injection pipette. Whereas in IVF, the sperm is mixed with the eggs to in the culture media to allow fertilisation to occur. In ICSI, we 'fertilise' the eggs with sperm manually and in IVF we let fertilisation occurs naturally. The treatment procedures of ICSI are similar to that of IVF.

The indications of ICSI are:

ICSI is a timing-consuming procedure. It requires skillful embryologist who has patient and concentration. It requires an advance inverted microscope, a micro-manipulator which will handle the sperm and eggs at high magnification. The whole process is done under microscopic visualization.

Before the sperm is injected into the egg, it is immobilised by scratching the sperm tail with micro injection pipette. After immobilisation, the sperm is aspirated into the micro injection pipette. The egg is held in place with the micro vacuum tip, with the polar body at six or 12 o'clock position. Then the sperm is injected into the egg at three o'clock position. The micro injection pipette will puncture a tiny hole in the ZP of the egg. The needle will go through this hole and deliver the sperm in the cytoplasm (see video). The tiny hole will seal by itself, recover, ans cause no harm to the embryo that is formed later.