Abstract
Intracytoplasmic sperm injection (ICSI) is the most effective assisted reproductive
procedure enabling fertilization in severe forms of male factor indications and male
gamete dysfunction. Reliability of ICSI has allowed the expansion of its application
to other forms of infertility rendering it the most popular assisted reproduction
technology (ART) insemination method worldwide. The concern related to the invasiveness
of ICSI together with the arbitrary selection of the inseminating spermatozoon has
induced the execution of studies to compare the performance of ICSI in non–male factor
infertility with standard in vitro insemination approach. Not surprisingly, the outcome
has evidenced that ICSI does not yield higher pregnancy rates than in vitro fertilization
but functions invariably as a normalizer of fertilization mollifying the absent or
low fertilization. The follow-up studies on ICSI children have evidenced that the
procedure is safe and the slightly higher incidences of neonatal malformations or
de novo gonosomal abnormalities are related to the genetics of the infertile couples.
Furthermore, ICSI is accepted for some specific indications such as low number and
poor morphology oocytes, thicker zona, excess polyspermia, PGD/PGS/PGT (preimplantation
genetic diagnosis/preimplantation genetic screening/preimplantation genetic testing),
discordant HCV/HIV (hepatitis C virus/human immunodeficiency virus) couples, in vitro
maturation (IVM), and oocyte cryopreservation. Only the advent of new biomarkers in
combination with routine semen analysis capable of identifying the fertilization competence
of the spermatozoon can guide the reproductive physician toward the proper insemination
method.
Keywords
intracytoplasmic sperm injection - male infertility - in vitro fertilization - spermatozoa
