For many years the only option for couples when the male partner had an extremely low sperm count, was donor insemination but as a process that takes IVF a step further, ICSI makes it possible to address this issue.

A single healthy sperm is injected into the centre of a woman's egg using a fine needle directed under a high-powered microscope. We hope this sperm will fertilize the egg so we can re-insert it as an embryo into your uterus. Fertilization rates after this procedure are between 50 and 70%.

The difference between IVF and ICSI is that IVF relies on fertilization to occur on its own - a sperm (one of several) must be able to penetrate an egg when they're placed together in a dish, whereas, with ICSI one healthy sperm is specifically selected to fertilize one healthy egg.

The success of the procedure is contingent upon the quality of the individual egg and the quality of the individual sperm. ICSI is considered when:

• The man has a low sperm count or poor sperm motility
• Sperm has to be extracted from the testicles or epididymis in cases of obstruction
• Antisperm antibodies
• Varicocele repair or a vasectomy reversal have failed
• Fertilization rates through IVF are low or absent

The process involves many of the same steps as IVF:

• The woman usually undergoes ovulation induction
• The best eggs are selected
• Sperm are washed
• One sperm is isolated and is placed into the centre of one egg
• After two or three days embryos (usually more than one egg is fertilized) are transferred into the woman's uterus

Even though sperm is actually injected directly into the egg, the process does not guarantee that fertilization will take place. In some instances, the sperm can be seen lying inside the egg after 48-hours without any evidence of fertilization.

There are some perceptions that ICSI should, perhaps, be performed for every case of IVF, to ensure that the sperm penetrates the egg to increase fertilization rates.

At the FRMC, we believe that ICSI should be performed only when necessary. We also believe that it is extremely important to establish whether or not the male partner's sperm are capable of fertilization through conventional IVF. This is necessary for diagnostic reasons and has implications for future treatment options.

There are numerous advantages and disadvantages with ICSI, which will be discussed prior to your egg retrieval.