Step-By-Step Procedure of ICSI

The following steps sum up the ICSI procedure:

Initial Phase

When this process begins, the female patient has to undergo fertility testing. It includes an inspection of the uterus and fallopian tubes and a hormonal analysis. The male will also have to go for his sperm analysis. After checking all of the results and tests, your doctor will get an idea about your health and will recommend the right treatment.

Ovarian Stimulation Phase

In this phase, you will have to stimulate your ovaries to develop as many follicles or egg-containing vesicles as possible. It will be done by injecting hormonal drugs on the second or third day of your period and every day for the next 9 to 12 days. The goal is to develop follicles that produce mature eggs that can be collected and used to achieve pregnancy.

Egg Retrieval and Sperm Collection Phase

Doctors will perform a little surgery to extract mature eggs from your follicle after 36 hours from the trigger shot. They will use ultrasound to insert needles into your pelvic cavity for egg retrieval. They will also retrieve your partner’s sperm on the same day of your egg retrieval. The collected semen is allowed to liquefy for around 30 minutes before being washed to remove debris, immobile sperm, and other undesired particles. They will then analyse the processed semen to check sperm quality. After this, doctors will decide whether IVF or ICSI will be used for infertility treatment.

Fertilization (insemination) & embryo development

About 4 hours after egg retrieval, the sperm sample, washed and concentrated, is added to the eggs. Both the sperm and the eggs are placed in an incubator overnight to be examined the next day for signs of fertilization in the eggs. If the sperm sample appears normal, around 60-70% of eggs may fertilize.

An embryologist may speak with you and discuss the results of fertilization, which may help alleviate your concerns. The fertilized eggs are then placed in the incubator for an additional 48 hours. In cases of poor sperm quality, such as low sperm count, poor motility, or abnormal morphology, the doctor may recommend Intracytoplasmic Sperm Injection (ICSI) as part of the IVF treatment. ICSI is an advanced technique used during IVF in which a single sperm is directly injected into a mature egg to facilitate fertilization.

Embryo Development

After the eggs and sperm are fertilised, they develop into embryos. These embryos are carefully cultured in a specialized incubator for 5–6 days until they reach the blastocyst stage, making them ready for transfer.

For the majority of patients, the embryos are frozen at the blastocyst stage and transferred later during a Frozen Embryo Transfer (FET) cycle, allowing the uterus to be optimally prepared for implantation.

Embryo Transfer

After embryo development, the embryologist selects one or more healthy blastocysts for transfer into the uterus. Using ultrasound guidance, the clinician carefully places the embryo into the uterine cavity, where it may implant into the uterine lining and continue to grow and develop. Approximately 10 to 14 days after the embryo transfer, a Beta hCG blood test is performed to confirm pregnancy.

During this stage, embryos are nurtured in a carefully controlled laboratory environment that supports their growth and development. Embryologists closely monitor embryo progression and assess their quality at each stage. Only embryos that meet strict developmental criteria are selected for transfer, improving the chances of successful implantation and pregnancy. This careful selection process plays an important role in the success of IVF and ICSI treatments.