Do you have to do ICSI with IVF? What’s the difference?

It is not always necessary to have ICSI with IVF. There are certain clear indications where IVF would be performed, and there are certain clear signs where we would recommend performing ICSI (Intracytoplasmic sperm injection).


IVF is recommended for patients who have been experienced tubal factor infertility. To couples who have had a history of conception in the recent past or at least in the last two years and have failed to conceive since then we would then recommend again doing an IVF rather than an ICSI. On the other hand, if there are couples where the female partner has an anovulation or lack of ovulation in that situation we once again may recommend performing an IVF rather than doing an ICSI.


ICSI is recommended in patients with male factor infertility or when couples have had unexplained infertility or unexplained subfertility for over two years duration. Also, it is recommended if they have had conceived before and have experienced unexplained subfertility of more than two years we would once again recommend doing ICSI.

ICSI may also be performed in certain patients where there is a total absence of sperms in the ejaculate, and we have retrieved the sperms performing a surgical sperm recovery then ICSI is required.

These are the broad implications where we would recommend doing an IVF or doing an ICSI in the patients.

IVF process

In IFV the process involves that first women have to take fertility drugs or medicines to stimulate the development multiple follicles and these follicles are then tracked. Once it’s considered that the eggs are mature enough and are ready for collection then you would undergo a procedure called an egg collection, it’s a minor surgical procedure. We retrieve the eggs as part of IVF we would inseminate the eggs, leave the eggs with the sperms in the petri dish and the fertilisation happens naturally. The embryologist will perform the checks on the next day to confirm fertilisation.

ICSI process

However, during ICSI, the embryologist will prepare and centrifuge the sample, select the health looking sperms under the microscope which has a high magnification microscope and then inject a healthy-looking sperm into one mature egg. Only one sperm is injected into each mature egg.

By doing this, we are facilitating the entry of the sperm into the egg. In some cases, we may recommend doing IMSI or intracytoplasmic morphologically selected sperm insemination that is the case where we have experienced very low fertilisation rates after having performed ICSI.

Difference IVF & ICSI

This is the kind of large difference in between IVF and ICSI. Patients undergoing IVF have to go through the full process just like an IVF. Why should not everyone have ICSI rather than having an IVF to give themselves the best possible chance and whether the human judgment in selecting the sperm can affect the outcome of the treatment?

Most of these assisted reproductive technology procedures still involve a lot of use of external interventions, chemicals and therefore one has to be careful when what method is required.

I think what is crucial is to have a judicious use of the procedures. In ICSI when there is a human judgment involved, there is a small potential that we might not have picked up a healthier sperm. I think it’s difficult to judge because the assessment is morphological rather than functional. That is one of the reasons why we should avoid the procedure if it is not indicated.

The other aspect is there still a slight increase in birth defects in babies born following ICSI. What we don’t understand at this given point of time whether it’s the underlying cause of male infertility that contributes to the increase in the birth defects or whether it is the procedure in itself can be lead to the birth defects on its own.

Currently, we also have a new era of the medicine that is now coming up as epigenetics. Epigenetics is where lots of external interventions have been used, and here the embryos are being exposed to the external environment and the chemicals that can then it self-induced mutations and genetic changes and can lead to the abnormalities. So one has to be very judicious and careful in recommending and performing IVF or ICSI, which should only be used for the patients as clinically indicated.