Treating Male Infertility: Intracytoplasmic Sperm Injection

For couples struggling to conceive, infertility is more common in Singapore than many realise. Around one in seven couples experience fertility challenges, with male factors contributing to approximately 50–60% of cases, either alone or in combination with female factors.

Intracytoplasmic sperm injection (ICSI) is a well-established assisted reproduction technique designed to address these challenges. When issues such as low sperm count, reduced motility or abnormal sperm structure interfere with fertilisation, ICSI offers a targeted method of overcoming male-factor infertility and supporting conception.

What Exactly Is Intracytoplasmic Sperm Injection (ICSI)?

ICSI is an assisted reproductive technique in which a single sperm is injected directly into the cytoplasm of a mature egg under high-power microscopic guidance. It is performed as a specific step within an IVF cycle and is carried out by trained embryology professionals in a closely controlled laboratory setting.

The key difference between ICSI and conventional IVF lies in how fertilisation occurs. In standard IVF, thousands of sperm are placed together with an egg, allowing fertilisation to take place through natural sperm-egg interaction. In ICSI, a carefully selected sperm is instead injected directly into the egg using specialised micro-instruments.

Outcomes vary between individuals and depend on multiple biological factors.

When Is ICSI Considered?

ICSI may be recommended when a detailed assessment has found that male infertility is causing difficulty in achieving a pregnancy. Whether due to issues involving semen quality, sperm production, sperm function or reproductive anatomy, there exists an underlying problem that compromises the sperm's ability to reach or fertilise an egg. Several root causes of this male infertility are:

• Hormonal disorders affecting sperm production
• Testicular factors such as injury, previous infection, or genetic conditions
• Varicocele (enlargement of veins within the scrotum)
• Ejaculatory disorders
• Obstructive conditions that block sperm transport

ICSI may also be discussed when standard in vitro fertilisation (IVF) has resulted in unsatisfactory fertilisation rates or when sperm parameters are significantly affected. A urologist or fertility specialist must ultimately determine the appropriateness of ICSI based on specific clinical findings and test results unique to each couple.

What Are Some Indications of Male Infertility?

Common indications of male infertility include:

• Low sperm count (oligozoospermia)
• Reduced sperm movement (asthenozoospermia)
• Abnormal sperm shape (teratozoospermia)
• Obstructive or non-obstructive azoospermia, where sperm must be obtained through surgical retrieval
• Very low sperm numbers after laboratory preparation

What Diagnostic Evaluations Are Necessary Before ICSI?

Before ICSI or any other form of assisted reproductive technology is considered, a fertility clinic needs to conduct a thorough assessment. This process helps identify the underlying causes of infertility and supports informed treatment decisions.

The evaluation typically includes the following components:

• Semen Analysis: This test assesses sperm count, motility, and morphology, providing essential information about overall sperm quality.
• Hormonal Testing: Blood tests are used to measure testosterone and other reproductive hormone levels that influence sperm production.
• Physical Examination: A physical examination allows the clinician to identify anatomical or structural abnormalities within the reproductive system.
• Genetic Testing: In selected cases, genetic testing may be recommended, particularly when severe low sperm count or azoospermia is present.
• Ultrasound or Imaging Studies: Imaging is performed when a structural or obstructive cause of infertility is suspected.

How ICSI Works: Step-by-Step Overview

ICSI forms part of a standard IVF treatment cycle and follows many of the same steps as a traditional IVF procedure. The key difference lies in how fertilisation is achieved in the laboratory.

The process typically involves the following stages:

• Ovarian Stimulation and Egg Retrieval: The female partner undergoes a protocol of controlled ovarian stimulation, followed by an egg retrieval procedure to collect the mature oocytes.
• Sperm Preparation or Retrieval: Sperm may be derived from a standard ejaculated semen sample. Alternatively, if ejaculation is not possible or the sperm count is extremely low, sperm may be obtained via surgical retrieval procedures.
• Microinjection of Sperm into the Egg: This is the ICSI-specific step, where a single sperm is injected into each mature egg using highly specialised microinjection equipment, all performed by expert embryologists.
• Embryo Culture: Once fertilisation occurs, the fertilised eggs (zygotes) are monitored in the laboratory setting as they progress and develop into embryos.
• Embryo Transfer: One or more of the viable embryos may be transferred into the uterus. Any remaining suitable embryos can be stored (cryopreserved), subject to the clinic's protocols and the couple’s wishes.

Every stage in this process is strictly regulated and performed by skilled professionals in licensed fertility clinics.

Potential Benefits and Limitations of ICSI

As with any assisted reproductive treatment, it is important to consider both the potential benefits and limitations of intracytoplasmic sperm injection when discussing suitability and expectations.

Potential Benefits

In specific clinical situations, ICSI may offer meaningful advantages:

• Fertilisation may be achieved in cases where sperm are unable to penetrate the egg using conventional IVF methods.
• The technique allows very small numbers of sperm to be used, which is particularly relevant if the male partner is suffering from a low sperm count.

Limitations

The technique also has certain limitations that must be considered:

• ICSI does not correct the underlying cause of male infertility.
• Outcomes such as fertilisation, embryo development and pregnancy depend on a range of biological factors beyond the procedure itself.
• The treatment carries similar time commitments, financial costs, and emotional demands as standard IVF.

Explore ICSI and Other Fertility Treatment Options

ICSI offers a potential pathway forward for couples facing specific sperm-related challenges. However, depending on the underlying cause of male infertility and the results of a full clinical assessment at a urological health clinic, other treatment approaches may be appropriate.

These may include:

• Conventional IVF: This may be suitable when sperm count, movement and morphology are not severely affected.
• Medication: Antibiotics, antioxidants, and hormonal treatments may address the underlying causes of male infertility.
• Surgical Treatment: Male infertility may sometimes be managed through surgical procedures such as varicocele repair and epididymal blockage removal.
• Lifestyle and General Health Changes: Addressing factors such as weight, smoking, alcohol use and underlying medical conditions may support fertility outcomes.

At Urology Practice, we strive to provide high-quality, targeted and compassionate care to help men struggling with fertility. Through a diagnostic evaluation and personalised clinical assessment with our urologist Dr Jonathan Teo, we can determine whether ICSI is an appropriate option. Contact us today to schedule an appointment, so we can guide you towards the most suitable fertility treatment for your individual circumstances.