There are two techniques used to fertilize eggs during IVF: conventional insemination (simply referred to as IVF) or intra-cytoplasmic sperm injection (ICSI). 

IVF and ICSI have many similarities. However, the differences between them are very important to note as you make a decision about your treatment path.

What is conventional Insemination (IVF)?

In this technique, a woman’s eggs are surrounded by sperm in a petri-dish and ultimately one sperm fertilizes the egg. Conventional insemination (IVF) largely recreates the “best sperm wins” dynamic of natural conception. 

Fertilization by insemination relies on the normal healthy functions of the sperm as well as for the egg’s outer layer to be optimal. An egg’s outer layer may be thick or hard to penetrate due to egg quality or maternal age related issues.

And let’s face it, if both the sperm and egg were optimal, you may not need the assistance of IVF to conceive in the first place. 

A few other downsides to conventional insemination are:

These are all things that are important to know to help diagnose your case and help plan for the next steps in your journey.

What is ICSI?

In this technique an embryologist selects a single sperm from a man’s semen sample and injects it directly into the egg. ICSI is used in 90% of IVF cases that involve male factor infertility and 60% of cases that don’t.

Apart from the way the sperm is introduced to the egg, there are not too many other differences. The egg retrieval and the monitoring of the embryo remain the same. The transfer of the embryo does as well. 

Another variation of ICSI is called “PICSI” which stands for physiological ICSI, and uses a specialized dish coated in a substance called hyaluronan.  Healthy sperm are attracted to that enzyme and stick to it, they are later used to inject the egg with.

The success rates for ICSI (50-80%) are higher than IVF without ICSI (50%). Live birth and birth defect rates have been reported to be quite similar between the methods, but ICSI is especially important for couples who want to have their embryos genetically tested.

The downsides to ICSI is:

  • This microsurgery costs an additional $1,500 – $3,000. I
  • t can only be performed on “mature eggs” (ruling out ~20% of eggs retrieved).
  • 5 – 15% of eggs are damaged in the process.
  • Success rates vary by embryologist.
  • Pregnancy rates are slightly higher for IVF without ICSI (27% vs. 24%). 

Why would I need ICSI?

ICSI helps to overcome fertility problems, such as Male Factor issues where fertilization previously seemed impossible, to now be achieved if…

  • The male partner produces too few sperm to do artificial insemination (intrauterine insemination [IUI]) or IVF.
  • The sperm may not move in a normal fashion.
  • The sperm may have trouble attaching to the egg.
  • A blockage in the male reproductive tract that keeps sperm from getting out.

ICSI allows embryologists to look at the eggs and know the quality and maturation right after the egg retrieval, and determine if egg quality issues are present. ICSI helps…

  • Eggs that did not fertilize by traditional IVF, regardless of the condition of the sperm.
  • History of eggs in previous cycles having low fertilization rates using traditional IVF.
  • If in vitro matured eggs are being used.
  • If previously frozen eggs are being used.

What if your IVF Lab does ICSI, But you want to try conventional IVF? 

It’s in your best interest to do what your clinic does 99% of the time. Clinics have switched to ICSI for very very good reasons. It increases their patients’ success rates and decreases chances of contaminating DNA from sperm during PGT. The embryologist will be able to examine and inject the nicest looking sperm.  

Veering from the established standard of care for a lab (any lab) introduces another possibility to the mix; one of them is making an error. 

With all of this said, speak to your clinic about their success rates for women or couples with similar age and diagnosis. This will help you get a better understanding at what is best for you.