The ICSI in the male factor includes patients who suffer from:

severe Oligoastenoteratozoospermia
infertility due to issues with the immune system
Azoospermia
Microinjection of sperm recovered from the epididymis and testicle.

 

The decision to perform ICSI is performed on the day of oocyte retrieval, the sample results are fresh. Most specialists agree that ICSI should be performed when there are doubts about fertilization with conventional IVF.
The most outstanding feature of ICSI is that results are not influenced by either the concentration or the mobility and sperm morphology, thus, seminal parameters are not common in the ICSI prognosis. The most important requirement on the microinjection is for the sample to at least have one live sperm for each of the recovered oocytes.

 

ICSI with ejaculated sperm used in extreme cases

 

These cases involve patients with cryptozoospermia where there are fewer than 100,000 sperm per ml, total asthenozoospermia, in which all sperm are immobile, and teratozoospermia and azoospermia in which sperm retrieved from the epididymis and testicle is used.
Patients who have sperm which is linked to antibodies or have some kind of dominant antibody, are not influenced by ICSI results as it is the technique used in these cases for assisted reproduction.

The microsurgical aspiration of sperm from the epididymis (MESA) in combination with ICSI has improved fertilization rates almost similar to those obtained with ICSI from ejaculated sperm.

The cryopreservation of sperm derived from the testis and epididymis allows the freezing of sperm surplus and thereby prevents the repetition of surgery in case new treatments are needed.

The Percutaneous Puncture Aspiration (PESA) technique is less invasive, has a lower cost and requires almost no training in techniques of microsurgery. Although the quality of the samples is lower than that obtained in MESA, these can be cryopreserved and used in subsequent cycles of ICSI.

There are cases in which the only source of spermatozoa is in the testis, and in these cases there is the possibility of fertilization and pregnancy by microinjection in order to obtain sperm from a biopsy of the testicle. Cryopreservation prevents the recurrence of testicular aspirations. This is an advantage for these types of cases due to the fact that inflammation and bruising has been found in areas of testicle, up to six months after the procedure has been done. It is also important because it is not possible to precisely predict the outcome of the aspiration, and thus ensures the availability of sperm before starting ovarian stimulation in women.

 

 

This option can be used in cases where no mature sperm were retrieved in the testicular biopsy Elongated or round spermatids, or even secondary spermatocytes must be microinjected. Results are usually very disappointing when using round spermatids because the In Vitro maturation of these immature forms is questioned, and the possibility of recovering spermatids for ICSI is not very common.

The ICSI in couples that have failed to achieve fertilization through IVF, reduces the risk of repeated failure and allows the achievement of superior fertilization rates by more than 70%. Non-fertilized oocytes have also been microinjected after conventional IVF treatment to take advantage of the cycle on the second day. Some copules achieve fertilization, but these embryos have high potential for poliployds and should not be transferred.

 There are other cases in which ICSI can be performed on patients with low response upon ovarian stimulation in order to ensure fertilization within the largest number of oocytes. ICSI is not justified in these cases due to the fact that there is some risk of oocyte degeneration through the process of decumulating or microinjecting it, as happens in patients with poor-quality oocytes; if conventional IVF is used, it would give these time to mature while remaining within the  sperm culture. If they are decumulated, we could certify that they are immature, just as oocytes with thickened pellucid zone or hard plasmic membrane. This would make sperm penetration through conventional IVF difficult, and in these cases, is assisted hatching is used in order to improve implantation and gestation rates.

 

In cases of couples with hereditary genetic diseases who begin a PGD program, ICSI ensures high rates of fertilization and prevents the adherence of sperm to the pellucid zone, which could affect genetic testing results after the biopsy of the embryo.