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About to undergo IVF or already an IVF warrior? Then you may be wondering about the benefits of conventional IVF vs. ICSI.
Both are forms of assisted reproductive technology where the egg is fertilized externally. But with intracytoplasmic sperm injection (ICSI), there’s an added layer of support with fertilization. This extra intervention is usually only necessary for those with severe male infertility.
It never hurts to have all the facts though. So keep reading to learn more about the difference between IVF and ICSI.
Takeaways
- For both IVF and ICSI, fertilization is done outside of the woman’s body in a lab. But in IVF, many sperm are placed near the egg for fertilization. And for ICSI, one sperm is injected into one egg.
- In general, ICSI is only beneficial for those with severe male infertility. It has been proven to improve success rates for this population.
- ICSI costs more than conventional IVF, and it also carries added risks. These include egg damage and genetic and chromosomal defects.
- Traditional IVF also has its risks though too. OHSS and multiple pregnancies are higher in IVF cycles than in natural cycles. The egg retrieval process and medications used can cause side effects as well.
- Overall, if you’re considering ICSI vs. IVF, it’s best to consult your medical provider to see if it’s the right treatment for you.
What is IVF?
In vitro fertilization (IVF) is a method of artificial reproductive technology (ART) where the sperm and egg fertilize in a laboratory.
With conventional IVF, the egg is surrounded by thousands of sperm inside a petri dish. Even though they’re in close quarters together, it’s still up to the sperm to fertilize an egg.
When fertilization does occur, an embryo forms and begins developing. Once the embryo reaches 3 or 5 days old, it will either get frozen or transferred to the woman’s uterus. This is called the embryo transfer (ET).
Know more: IVF Process: Your Step-by-Step Guide from Start to Finish
What is ICSI?
Intracytoplasmic sperm injection (ICSI) is actually a type of IVF. It’s sometimes referred to as IVF with ICSI or IVF/ICSI.
With ICSI, the embryologist injects a single sperm directly into the cytoplasm. (The cytoplasm is the liquid inside of the egg).
This injection process eliminates some of the “hard work” that the sperm has to do to find and penetrate the egg. That’s how ICSI can lead to a better chance of fertilization than conventional IVF for some patients.
But in the end, it still doesn’t guarantee fertilization will occur.
In the next section, you’ll get a better sense of who should consider doing IVF and ICSI.
Who benefits from ICSI?
On its own, IVF already controls a lot of the early processes of reproduction. For example, it helps with egg maturation and increases the odds of fertilization. This is what makes traditional IVF a helpful fertility option for many folks.
But for some patients, even more intervention is needed to successfully conceive. And that’s where ICSI comes in.
Here are the main cases where ICSI is beneficial:
1. Severe male factor infertility
A male is considered to have severe infertility when they have one or more of the conditions below:
- Severe oligozoospermia (severe low sperm count) – less than 5 million sperm per mL of semen
- Cryptozoospermia (crypto means “secret” or “hidden”) – sperm aren’t easily detected in the semen analysis. Additional examination is needed to actually find the sperm on the pellet.
Azoospermia – no sperm is present in the ejaculate.
2. History of IVF failure
For those who have tried IVF for multiple cycles with no success, ICSI may be the next treatment option.
3. When using previously frozen eggs or sperm to conceive
In cases where the eggs and/or sperm have already been frozen, ICSI is sometimes used.
4. Those undergoing preimplantation genetic testing (PGT)
For some patients who do preimplantation genetic screening, ICSI may be used. This is because, with conventional insemination, genetic residue from other sperm in the petri dish may stick to the outside of the egg.
So during the PGT biopsy, this could cause the analysis of the sperm to be inaccurate. But with ICSI, this risk is pretty much eliminated since an isolated sperm is used for the injection.
Besides who ICSI is right for, there are other differences you should know about too. These include things like the overall cost and risks.
For a more complete overview of ICSI and IVF differences, keep reading.
What is the difference between IVF and ICSI?
Remember, ICSI is a more advanced type of traditional IVF. So there’s a lot the two procedures have in common. But there are also quite a few differing factors.
In the table below, you’ll see an overview of how they measure up.
Factor | Conventional IVF vs. ICSI | |
How is it done? | IVF: Egg is surrounded by multiple sperm in a petri dish. Fertilization occurs naturally.
ICSI: A single sperm is directly injected into the egg | |
Amount of sperm required? | IVF: requires more sperm
ICSI: requires only one sperm | |
Who benefits? | IVF: Good for female infertility and mild to moderate male factor infertility
ICSI: Mainly for severe male factor infertility | |
Cost? | IVF: Less expensive
ICSI: Adds an additional ~$1500 to IVF | |
Success rates? | ICSI: Increases success rates for those with severe male infertility | |
Risks? | IVF: OHSS, risk of multiple pregnancy, side effects from medications
ICSI: Includes regular IVF risks plus a few more (like genetic abnormalities and egg damage) | |
Curious to know even more about these differences? Read more about each factor below.
How are IVF and ICSI procedures done?
In regular IVF, many sperm are placed into the same petri dish as the egg. From there, the sperm must work to naturally fertilize the egg.
In ICSI, a single sperm is injected into one egg. The sperm will still need to fertilize the egg, but some of the initial work has already been done for it.
How much sperm is required for IVF and ICSI?
As you can guess, more sperm are needed for traditional IVF. This increases the opportunities for the egg to become fertilized.
But with ICSI, technically only one healthy sperm is needed.
For whom is each procedure suitable for?
Traditional IVF is usually a treatment option in cases of female infertility. It also helps with mild to moderate male factor infertility.
If the male factor infertility is more severe, that’s when ICSI is considered.
Comparing IVF and ICSI costs
The cost of any fertility treatment varies. Expense factors include the state, the fertility clinic, and what your insurance covers. That said, on average conventional IVF runs about $2,000 per cycle. If you do ICSI, it can add an additional $1,500 to the total cost.
But if you’re considering either option, be sure to talk to your insurance provider. They can help you determine exactly what’s covered.
At this point, perhaps this question is still on your mind: Is IVF more successful with ICSI? And don’t worry–we’ll see exactly how the success rates compare in the next section!
Success rates of ICSI vs. IVF
If a male has no known fertility issues and normal sperm, success rates will be about the same with both traditional IVF and ICSI. That said, it’s pretty clear that in cases of severe male factor infertility, ICSI has greater success rates. The exact fertilization rates achieved do vary by lab though.
Current research mostly agrees that ICSI does not improve fertilization, implantation, or miscarriage rates in patients with non-male factor infertility. There may be one exception to this though.
One study looked at fertilization rates in ICSI versus IVF. The patients all had previous IVF failures due to total failed fertilization. The study used eggs from the same female patient and allocated some to undergo conventional IVF and others to proceed with intracytoplasmic sperm injection.
For the standard IVF cycles, the fertilization rate was 11%. But for the ICSI cycle, it was 48%. It’s unclear what the original reason for the total failed fertilization was. It could have been from poor egg quality, poor sperm quality, or both.
Either way, this research shows that ICSI may also be beneficial in cases where conventional IVF led to significantly lower than expected or failed fertilization rates.
Now, let’s say you are in fact a good candidate for ICSI. There are some additional risks you should consider. We’ll fill you in on all of these next.
What are the risks of ICSI vs IVF?
There are some risks associated with both of these fertility treatments. IVF can pose a risk for:
- Ovarian hyperstimulation syndrome (OHSS) – this happens when ovulation induction medications create swelling of the ovaries. OHSS can cause a range of symptoms like abdominal pain, nausea, and diarrhea.
- Conceiving multiples (this is a risk because multiples put the mother at risk for additional complications. Examples include preeclampsia and preterm birth.
- Side effects related to ovarian stimulation medications. Some symptoms you could experience include irritability, headaches, or hot flashes.
On top of these risks, ICSI can lead to additional complications. Learn more about these below:
1. Egg damage
The injection process in ICSI can damage the internal structures of the egg. These include the zona pellucida (a protective layer of the egg cell) and the cytoplasmic membrane (the cell membrane).
When the oocyte is damaged, chromosomal abnormalities and aneuploidy are possible. (Aneuploidy refers to missing or extra chromosomes).
2. Increased defects in the baby
Current studies don’t always agree on the extent to which ICSI is related to the risk of birth defects.
Some research shows that ICSI may increase the chances of a child having autism, chromosomal abnormalities, intellectual disabilities, and birth defects.
That said, it’s possible that ICSI itself is not to blame for these abnormalities. Instead, it could be caused by the underlying issues that led to the ICSI patient being infertile in the first place.
For example, children born through ICSI are at risk for inherited gene abnormalities. Researchers believe this is a result of the sperm used in ICSI being more likely to be abnormal.
But there are other studies like this one and this one that have found no significant difference between major birth defects when it comes to IVF and ICSI.
3. Urogenital abnormalities
One study of about 1,200 infants found that the odds of ICSI babies having hypospadias was 3 to 1 when compared to IVF babies. Normally, the opening of the penis is on the tip. But in those with hypospadias, it’s located on the underside instead.
This higher occurrence is likely a result of male infertility, not the ICSI procedure. But at this time, there’s no evidence proving the cause for sure.
4. Genetic defects transmitted from father to son
The inheritance of genetic defects is a final concern for offspring born via ICSI. Research estimates that 10%-18% of men with severely low sperm count also have microdeletions of the Y chromosome.
Unfortunately, these microdeletions can be passed down to male embryos during ICSI. So it’s recommended that men with oligozoospermia have chromosomal testing done.
These extra risks may sound overwhelming. But keep in mind, the overall chances of having a baby with no defects are still much greater.
Now if your brain is still feeling torn over the IVF versus ICSI dilemma, keep reading. We’ll sum up which may be the best option for you based on your circumstances.
What’s better, IVF or ICSI?
Neither fertility treatment is “better” than the other. It all depends on the root causes of infertility for the patient or couple.
If you or your partner suffer from severe male infertility issues, intracytoplasmic sperm injection is likely the best option.
But if male factor infertility is mild or a non-issue, then ICSI may not improve your odds of successful conception. And remember that ICSI is more expensive and carries additional risks. So it’s really only a good option for those who are likely to be unsuccessful with conventional IVF.
If you’re still unsure, talk it over with your fertility specialist. They can help review your medical history and order testing if needed to determine your fertility diagnosis.
FAQs
In cases of severe male infertility, yes, ICSI is more effective.
Yes, ICSI increases your fertility expenses. On average, it adds an additional $1,500 to what you would pay for conventional IVF. But the exact out-of-pocket cost depends on a few factors. Some include your fertility clinic and how much your insurance covers.
No. ICSI is an additional assisted reproductive technology treatment added on top of IVF. But you can do IVF without ICSI.
There are two major downsides. First, ICSI is more costly than IVF alone. And second, ICSI has additional risks like birth defects and genetic abnormalities. But to put things in perspective, there are risks with any pregnancy. And if you do conceive with ICSI, you’re still more likely than not to have a healthy child.
Yes, an embryologist will carefully inspect the semen to choose healthy sperm for the ICSI procedure.
Was this article helpful?
- Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion – ASRM
- FAQ: Intracytoplasmic Sperm Injection – UCSF Health
- Severe male factor in in vitro fertilization: definition, prevalence, and treatment. An update – PMC
- Understanding ICSI’s Costs – FertilityIQ
- Comparison of conventional IVF versus ICSI in non-male factor, normoresponder patients – PMC
- Laboratory handling of epididymal and testicular spermatozoa: What can be done to improve sperm injections outcome – PMC
- Congenital malformations and assisted reproductive technique: Where is assisted reproductive technique taking us? – PMC
- ICSI Key Findings | Assisted Reproductive Technology (ART) | CDC
- Full article: Comparative study on risk for birth defects among infants after in vitro fertilization and intracytoplasmic sperm injection
- Birth defects in children conceived by ICSI compared with children conceived by other IVF-methods; a meta-analysis | International Journal of Epidemiology | Oxford Academic
- Incidence of congenital malformations in children born after ICSI | Human Reproduction | Oxford Academic
- Male Infertility – StatPearls – NCBI Bookshelf
- Ovarian Hyperstimulation Syndrome – PMC
