Dr. Hrishikesh Pai discusses the indications for intracytoplasmic injection of a single spermatozoon into an oocyte (ICSI). ICSI can increase fertilization rates when lower than expected or failed fertilization has occurred with conventional insemination.  ICSI is indicated for deranged semen parameters. Not only ejaculated sperms but also surgically retrieved sperms can be used for ICSI.The chance of finding sperm with microsurgical testicular sperm extraction is better than 60% which is superior to finding sperm by non-microsurgical or needle.  ICSI may be of benefit for patients undergoing IVF with pre implantation genetic techniques, in vitro matured oocytes, previously cryopreserved oocytes, autologous and homologous mitochondrial transfer.

Dr. Pai discusses the contraindications to ICSI and the technique of ICSI, factors affecting ICSI outcome and methods of improving IVF-ICSI outcomes. These include improving sperm quality by semen preparation, de-selection of apoptic sperms, magnetic-activated cell sorting, selection of normal sperms [intra cytoplasmic morphologically selected sperm injection (IMSI), hyluronan acid binding (PICSI) hypoosmotic sperm test (HOST), motile sperm organellar morphology examination (MSOME)]. Newer techniques of sperm injection include use of poloscope (spindle view), laser, piezo and robotics.