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In 1992, the injection of a single sperm into a mature egg was performed for the first time. This revolutionary technique, called intracytoplasmic sperm injection (ICSI), gave men with extremely low numbers of motile sperm another option in addition to the use of donor sperm. For the first time, they could father their own biological children. ICSI is used in the following cases:
• Severe male factor infertility as indicated by a low sperm count
• A large number of abnormal sperm
• Low or absent sperm motility
• Problems with sperm binding to the egg or antisperm antibodies on the sperm surface that can interfere with the fertilization process
Since only very few sperm cells are needed for ICSI, it is possible to use epididymal or even testicular sperm for fertilization of eggs, if ejaculated semen is not available. Sperm cells from any of these sources can be cryopreserved (frozen) for use in a future treatment cycle. As the use of ICSI became standard clinical practice, the indications for ICSI increased and now can include previous failed fertilization (for any reason) and egg factors such as defects which allow more than one sperm to enter the egg.
The ICSI procedure involves the same ovarian stimulation and egg retrieval as standard in vitro fertilization (IVF). A mature egg is selected, and the semen sample is processed to optimize the sample in terms of sperm motility and viability. A single sperm is immobilized and then injected into the egg.
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