Intra Cytoplasmic Sperm Injection (ICSI)
What is ICSI?
ICSI stands for Intra-Cytoplasmic Sperm Injection. It is a specialised form of IVF in which a single sperm is injected directly into a mature egg using an ultra-fine needle under a high-powered microscope. When a couple is struggling to conceive and the issue lies with sperm – whether that’s low count, poor movement or abnormal shape- standard IVF often isn’t enough. IVF relies on sperm finding and penetrating the egg on their own. When sperm can’t do that, you need a different approach.
ICSI (Intra-Cytoplasmic Sperm Injection) solves this by removing the obstacle entirely. Instead of placing sperm near an egg and waiting, our embryologists select a single healthy sperm and inject it directly into the egg. It is one of the most effective treatments for male-factor infertility available anywhere in the UAE.
The technique was developed in the early 1990s and transformed the treatment of severe male infertility. Before ICSI, men with very low sperm counts or non-functioning sperm had almost no path to biological fatherhood. ICSI changed that. Today it is a standard, well-established procedure performed routinely at Conceive Hospital’s clinics in Sharjah and Dubai.
Everything else about an ICSI cycle – ovarian stimulation, egg retrieval, embryo culture, embryo transfer – follows the same process as a standard IVF cycle. The difference is only in how fertilization happens.
Who is ICSI for?
ICSI is recommended when male-factor infertility is the primary or contributing reason a couple has not conceived. At Conceive Hospital, our specialists assess each couple thoroughly before recommending ICSI. It is typically the right choice when:
The sperm count is very low. Standard IVF needs a reasonable number of healthy sperm to give fertilization a chance. When counts are severely low, ICSI bypasses that threshold entirely – we only need one good sperm per egg.
Sperm motility or morphology is poor. If sperm move slowly, move abnormally, or are misshapen, they struggle to penetrate the egg naturally. ICSI removes the need for the sperm to do that work.
There is no sperm in the ejaculate (azoospermia). In cases where no sperm appears in the semen – whether due to a blockage, a previous vasectomy, or a production problem – sperm can often be retrieved surgically through PESA or TeSA. That retrieved sperm is then used directly in ICSI.
Previous IVF cycles have failed to fertilize. If eggs were collected but did not fertilize in a prior IVF attempt, ICSI is the standard next step.
Ejaculation is difficult or not possible. Including retrograde ejaculation, erectile dysfunction, or spinal cord injuries – sperm can be retrieved and used in ICSI.
The woman has unexplained recurrent miscarriages. In some cases, poor embryo quality related to sperm DNA fragmentation plays a role. ICSI, particularly with PICSI (see below), can improve embryo quality and reduce miscarriage risk.
PCOS or endometriosis is also present. ICSI is often used alongside the treatment of these conditions when male-factor infertility is also a factor.
How ICSI works, step by step
An ICSI cycle at Conceive Hospital follows the same overall structure as IVF, with one critical difference at the fertilization stage.
Step 1 – Ovarian stimulation The woman takes hormone injections for ten to fourteen days to stimulate the ovaries to produce multiple mature eggs. Progress is tracked with blood tests and ultrasound scans.
Step 2 – Egg retrieval When the eggs are ready, they are collected in a short procedure under light sedation. It takes around twenty minutes and patients go home the same day.
Step 3 – Sperm collection or retrieval A sperm sample is provided on the same day. If there is no sperm in the ejaculate, sperm is retrieved surgically (PESA or TeSA) – often on the same day, or in a planned separate procedure.
Step 4 – The ICSI procedure In the laboratory, each mature egg is held steady under a microscope while our embryologist uses an ultra-fine glass needle to inject a single carefully selected sperm directly into it. This takes precision and expertise – the quality of this step matters enormously. The injected eggs are checked the following morning. Successfully fertilized eggs begin dividing and developing into embryos.
Step 5 – Embryo development and monitoring Embryos are cultured for two to five days using time-lapse monitoring technology, which allows our team to observe development continuously without disturbing the embryos.
Step 6 – Embryo transfer One or two of the best-quality embryos are transferred into the uterus through a thin catheter – a simple, painless outpatient procedure. Any remaining healthy embryos can be frozen.
Step 7 – Pregnancy test A blood test two weeks after transfer confirms whether implantation has been successful.
PICSI – an upgrade to standard ICSI
Standard ICSI leaves sperm selection largely to the embryologist’s visual judgment under the microscope. An apparently normal-looking sperm isn’t always mature or chromosomally healthy.
PICSI (Physiological Intra-Cytoplasmic Sperm Injection) adds a biological selection layer. Mature, high-quality sperm have a natural ability to bind to hyaluronan – a substance found in the cells surrounding the human egg. Immature or chromosomally abnormal sperm bind poorly or not at all.
In a PICSI procedure at Conceive Hospital, sperm are placed in a dish coated with hyaluronan dots. Only the sperm that bind successfully – the most mature, most chromosomally normal – are selected for injection. Studies show these sperm produce embryos with lower rates of chromosomal abnormalities and higher pregnancy rates.
If you have a history of recurrent miscarriage, failed ICSI cycles, or known sperm DNA fragmentation, PICSI is worth asking our team about.
Questions patients ask about ICSI
For couples where male-factor infertility is the issue, yes – ICSI typically achieves significantly higher fertilization rates than standard IVF. For couples where sperm quality is normal, the fertilization rates of IVF and ICSI are broadly similar.
The ICSI procedure itself takes place in the laboratory – the patient experiences nothing during it. The parts the woman experiences – injections, egg collection under sedation, and embryo transfer – are the same as a standard IVF cycle. Most patients find the process much less uncomfortable than they anticipated.
A complete ICSI cycle at Conceive Hospital takes four to six weeks, from the start of ovarian stimulation to the pregnancy test.
This is called azoospermia, and it doesn’t necessarily rule out biological fatherhood. Conceive Hospital offers PESA and TeSA – surgical sperm retrieval procedures that can obtain sperm directly from the epididymis or testicle. That sperm is then used in ICSI. Our team will assess whether surgical retrieval is appropriate based on the underlying cause of azoospermia.
Yes, in many cases. Sperm can be surgically retrieved through PESA even after a vasectomy that cannot be reversed. This is assessed on a case-by-case basis at Conceive Hospital.
Standard ICSI involves an embryologist visually selecting the best-looking sperm for injection. PICSI adds a biological test – only sperm that bind to hyaluronan (a substance found near the egg) are selected. This produces sperm that are more mature and chromosomally healthier. Conceive Hospital offers PICSI for patients where improved sperm selection is clinically indicated.
This is one of the most common questions we hear, and the honest answer is nuanced. Children born through ICSI have slightly higher rates of some genetic conditions – but much of this is attributable to the underlying male infertility rather than the ICSI process itself. The overall risk remains low. Our team discusses this openly with every patient so you can make an informed decision.
Conceive Gynecology and Fertility Hospital operates clinics in Sharjah (near Arab Mall, Al Taawun) and Dubai (Jumeirah Lake Towers, near Damas Jewellery). We serve patients from Abu Dhabi, Ajman, Ras Al Khaimah, and all UAE emirates.
Reach us
Sharjah – Near Arab Mall (Old Al Taawun Mall), Al Taawun, Sharjah Tel: +971-6-5771822 | Mobile: +971-50-8475666
Dubai (JLT) – Near Damas Jewellery Showroom, Jumeirah Lake Towers, Dubai Tel: +971-4-5545 820 | Mobile: +971-50-5817003