ICSI & PICSI

ICSI
Intracytoplasmic sperm injection, or ICSI for short, is a procedure where your partner's sperm is injected directly into your egg(s) for fertilization with IVF. You may have questions about using ICSI with IVF for male infertility and we are here to help. Here are some answers to common questions about ICSI.

The ICSI procedure can help you and your partner get pregnant despite certain male infertility problems, like the following:
  • Sperm unable to penetrate or fertilize an egg, low sperm count or poor sperm quality
  • A blockage or anatomical abnormality in the male's reproductive tract that prevents him from producing or ejaculating sperm
  • Men who require a testicular or epididymal biopsy in order to conceive (such as after a vasectomy)

Why Use ICSI?

ICSI has been a tremendous benefit to IVF for over a decade and has revolutionized the treatment for couples that have severe male infertility. Know that even if there are no issues with your partner's sperm, your doctor may still recommend ICSI with IVF. ICSI is often helpful even for couples that have not been successful with IVF in previous cycles.

Facts About ICSI

The ICSI procedure is becoming more common in IVF clinics because it virtually guarantees that the sperm penetrates the egg. In 2010 over half of all IVF cycles performed in the U.S. used ICSI. And, the vast majority (87 percent) of couples dealing with male factor infertility used ICSI with their IVF cycles.

With the ability to fertilize an egg with just one sperm, many infertile couples are finally becoming pregnant. If you're dealing with male factor infertility or other fertility problems, talk to your doctor about the ICSI procedure.

PICSI: Only Mature Sperms Fertilize an Egg
Couples, who experienced a failure in fertilization at other clinics, often come to us. We offer them a PISCI method, which is an improvement of the ICSI procedure. Only specially selected sperms are used for the fertilization, which we inject into the egg. The probability of fertilization is thus greatly increased.

In what cases is PICSI suitable:
  • repeated unsuccessful IVF or even ICSI
  • poor embryo quality
  • repeated miscarriages

Physiological ICSI (PICSI) vs. Conventional ICSI in Couples with Male Factor: A Systematic Review

The results of this systematic review were not statistically significant for all outcome measures. With respect to the risk of bias in the included studies, most of our results showed "uncertain risk of bias", since the randomization and blinding of participants is not essential, due to the nature of the studies. This risk was considered to be irrelevant, since in order to carry out the procedures, one must know which technique to apply and which one is adequate for each patient, and for this reason, we need to know the characteristics of the case. However, for the risk caused by other potential bias sources, both studies had a "high risk of bias," since they did not take into account sperm morphology, concentration and motility, which are fundamental parameters to determine the implementation of the PICSI or ICSI technique.

With respect to "statistical heterogeneity", we know that it only quantifies the variability between the study's results, and that it can be due to real differences related to the approach and execution of the included studies, or to other causes. In other words, it tries to quantify the variability in the results, that is measured in the different studies, with respect to the average global outcome, and to determine whether this variability is higher than what would be expected merely by chance.

The negative values of the statistical I2 are made to be equal to zero, so that the I2 is between 0% and 100%. A value of 0% shows that there is no observed heterogeneity and the greater values show a growing heterogeneity. Having markers that indicate the degrees of heterogeneity, 25% is considered to be "low statistical heterogeneity", 50% shows "moderate statistical heterogeneity" and 75% implies "high statistical heterogeneity". These markers are attributable to the statistical heterogeneity of the studies, and not to chance. An I2 of 0% is considered to have "excellent statistical homogeneity" and if variability existed in the estimation of the effects, this would be due to sampling error in the trials, and not to heterogeneity. This is the case in outcomes of live births, clinical pregnancy and miscarriage, in our review, since the results do not vary more than what would be expected from influence by chance. Finding a "low statistical heterogeneity" for the implantation outcome leads us to consider that there is scarce variability attributable to statistical heterogeneity between the studies and not to chance. Also, for embryo quality outcomes, we found "moderate statistical heterogeneity", considering it to be a moderate variability, attributable to the statistical heterogeneity between the studies and not to chance. On the other hand, for the fertilization outcome, we found a "high statistical heterogeneity", showing that the greatest part of the variability between the studies is due to heterogeneity, more than chance.

In order to decrease the "statistical heterogeneity" in this systematic review, it is important to guarantee that there is no "clinical heterogeneity" that would make the combination of results impossible, but it is not possible to maintain a "low clinical heterogeneity" because few studies fulfilled our inclusion criteria; due to their high risk of bias, resulting in a limitation. As a consequence, only two studies were included in this systematic review.

As far as we know, this is the first systematic review that compares PICSI vs. ICSI in the prognosis of couples with male factor, taking into account the following outcome measures: live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage. We suggest that future studies be carried out according to the CONSORT guidelines; however, due to the nature of the intervention, it would be difficult to achieve blinding of the embryologist when performing the fertilization technique (PICSI vs. ICSI). The risk of bias could be reduced in blinding for outcome analysis and of the personnel performing the embryo transfers. It is important that these future studies provide quantitative information on results and that the rates of miscarriages, live births and clinical pregnancy be considered as primary results, without ignoring rates of implantation, fertilization and embryo quality, for the comparison of the techniques. We also recommend including the analysis of subgroups, in order to eliminate variables that affect results, such as sperm quality (morphology, concentration and motility), cause of female and male infertility, number and quality of transferred embryos, day of embryo transfer, fresh or frozen transfer, own oocyte or donated oocyte.