Procedure
One selected sperm is injected into a mature oocyte using a micropipette.
IVF Treatments · Laboratory Fertilisation Method
Intracytoplasmic Sperm Injection (ICSI) Treatment
ICSI is an advanced fertilisation method in which an experienced embryologist places a single sperm cell directly into a mature oocyte with microscopic precision. The decision to use ICSI is individualised after considering semen analysis, oocyte characteristics and previous treatment outcomes together.
- The need for ICSI is assessed according to clinical indication rather than used routinely
- Sperm preparation and microinjection are performed in the embryology laboratory
- Fertilisation, embryo development and transfer outcomes are monitored as separate stages
Understand the treatment in 1 minute
ICSI Treatment at a Glance
Who may be suitable?
It may be considered in selected cases involving significant male factor infertility, surgically retrieved sperm, or previous low or failed fertilisation.
Laboratory stage
Oocyte maturity is checked, sperm is prepared and the microinjection procedure is performed by an experienced embryologist.
What happens next?
Fertilisation is checked, embryo development is monitored and an individual fresh or frozen embryo transfer plan is prepared.
Key information
What Is Intracytoplasmic Sperm Injection (ICSI)?
ICSI stands for “Intracytoplasmic Sperm Injection”. It is a laboratory fertilisation method used as part of IVF treatment.
In brief:
During ICSI, an embryologist uses a very fine injection pipette to place one selected sperm cell into the cytoplasm of a mature oocyte. The aim is to support fertilisation when sperm may have difficulty penetrating the oocyte on its own.
ICSI is not a separate pregnancy treatment; it is one of the fertilisation methods used during the laboratory stage of IVF. Ovarian stimulation, oocyte collection, embryo culture and transfer planning follow the same overall IVF pathway. The key difference from conventional IVF is how the oocyte and sperm are brought together in the laboratory.
Before the procedure, the cells surrounding the oocytes are carefully removed and oocyte maturity is assessed. Only mature oocytes considered suitable for microinjection are used. The sperm sample is prepared according to concentration, motility and appearance; a selected viable sperm is immobilised and injected into the oocyte.
ICSI can help overcome some barriers at the sperm–oocyte interaction stage, but it cannot guarantee biological fertilisation, healthy embryo development, implantation or live birth. Outcomes are therefore considered separately from fertilisation through to live birth.
- A single sperm cell is selected and injected into a mature oocyte.
- The procedure is performed in an embryology laboratory equipped with a micromanipulation system.
- Fertilisation is usually assessed the following day.
- The need for ICSI is determined according to semen analysis and treatment history.
Method comparison
What Is the Difference Between Conventional IVF and ICSI?
In both methods, fertilisation takes place outside the body. The main difference is how sperm reaches the oocyte.
Sperm reaches the oocyte independently
A prepared concentration of sperm is placed in the culture medium with the oocyte. One sperm is then expected to penetrate the oocyte membranes and initiate fertilisation.
- It may be considered when sperm parameters are suitable.
- More of the natural interaction around the oocyte is retained.
- The possibility of unexpectedly low or absent fertilisation cannot be completely eliminated.
One sperm is placed directly into the oocyte
The embryologist selects a suitable viable sperm and injects it into a mature oocyte using a very fine pipette. This bypasses the step in which sperm must penetrate the oocyte membranes.
- It is an established option in significant male factor infertility.
- It can be used with surgically retrieved sperm and warmed oocytes.
- Routine use has not been shown to provide an additional live-birth benefit for every patient.
Important decision point:
The fact that ICSI is a more technically advanced laboratory method does not mean it automatically produces better outcomes for every patient. Current evidence supports choosing the method according to male factor findings, previous fertilisation results and the characteristics of the gametes being used.
Suitability assessment
Who May Be Suitable for ICSI Treatment?
The decision is not based on a single semen-analysis result. Male and female fertility assessment, the number of available oocytes, previous treatments and the laboratory plan are considered together.
Markedly reduced sperm concentration
ICSI may be considered when the number of motile sperm capable of reaching the oocyte is severely reduced.
Reduced motility or abnormal morphology
Poor progressive motility or significant abnormalities in sperm morphology may make conventional fertilisation more difficult.
Surgically retrieved sperm
A limited number of suitable sperm retrieved through PESA, MESA, TESE or Micro-TESE may be used with ICSI.
Previous fertilisation failure
It may be considered in a subsequent cycle if conventional IVF previously resulted in no fertilisation or markedly lower fertilisation than expected.
Use of frozen oocytes
ICSI is an established fertilisation approach for warmed mature oocytes because the surrounding cells have already been removed as part of the freezing process.
Certain genetic testing plans
It may be preferred in selected situations, such as some PGT-M plans, where contamination by external cells or sperm could affect the accuracy of analysis.
Is ICSI used for every patient?
No. In patients with normal semen parameters, no previous fertilisation problem and no specific laboratory indication, routine ICSI has not been shown to increase live-birth rates.
When might ICSI provide no additional benefit?
Advanced female age, reduced ovarian reserve, a low number of collected oocytes or unexplained infertility alone may not be sufficient reasons to use ICSI. An individual risk–benefit assessment is required.
Before treatment
What Is Done Before Starting ICSI Treatment?
The decision to use ICSI is part of the couple’s overall fertility assessment. Current investigations, previous treatment attempts and individual treatment goals are reviewed for both partners.
Initial consultation and medical history
Duration of infertility, previous pregnancies, miscarriages, surgery, current medication and previous IVF outcomes are reviewed.
Female fertility assessment
Ultrasound findings, ovarian reserve, hormone tests, uterine and tubal history and general health are assessed.
Semen analysis
Sperm concentration, motility, morphology and sample quality are evaluated; testing may be repeated when appropriate.
Urological assessment
In severe male factor infertility, azoospermia, varicocele or when surgical sperm retrieval is planned, urological review and hormonal or genetic testing may be required.
Previous laboratory records
The number of mature oocytes, fertilisation rates, embryo development and transfer outcomes can directly influence the choice of fertilisation method.
Genetic assessment
When sperm concentration is extremely low, there is impaired sperm production or a relevant family history, genetic counselling and appropriate testing may be considered.
Medication and timing plan
Ovarian stimulation, monitoring appointments, final maturation injection and oocyte collection are scheduled according to the individual protocol.
Travel coordination
For patients travelling from Turkey, the United Kingdom or other parts of Europe, investigations may be reviewed remotely and procedure dates in Cyprus can be planned in advance.
Step-by-step process
How Is ICSI Treatment Performed?
Although the laboratory microinjection procedure itself takes place on a single day, the overall treatment is a multi-stage team process from ovarian stimulation through to pregnancy testing.
Initial assessment and treatment decision
Semen analysis, ovarian reserve, previous treatment attempts and individual circumstances are reviewed to decide whether conventional IVF or ICSI is appropriate.
Ovarian stimulation
An individual medication protocol is used to support the development of multiple follicles. Monitoring is performed with ultrasound and hormone tests when required.
Oocyte collection
When the follicles reach an appropriate size, the final maturation injection is timed and oocytes are collected under sedation or anaesthesia.
Preparation of the sperm sample
A fresh sample provided on the same day, a previously frozen sample or surgically retrieved sperm is prepared in the laboratory and suitable viable sperm cells are selected.
Assessment of oocyte maturity
The surrounding cells are removed from collected oocytes. Only mature oocytes at the metaphase II stage that are suitable for ICSI are used.
Microinjection procedure
The oocyte is stabilised with a holding pipette. One selected sperm is introduced into the oocyte with an injection pipette, after which the oocyte is returned to a controlled culture environment.
Fertilisation and embryo monitoring
The following day, the oocytes are assessed for signs of normal fertilisation. Developing embryos are monitored according to the laboratory protocol and a transfer or freezing decision is made.
Transfer and pregnancy testing
A suitable embryo may be transferred fresh or as a frozen embryo in a later cycle. A blood beta-hCG test is performed on the date specified by the clinic.
Procedure day and afterwards
What Happens During and After ICSI?
On the day of the procedure
ICSI is performed in the embryology laboratory while the patient is not in the laboratory. Oocytes and the sperm sample are prepared using identity-verification steps. The laboratory team processes only mature oocytes considered suitable for injection.
Fertilisation assessment
Injected oocytes are cultured under controlled conditions. The following day, the number showing normal fertilisation is reported. Oocytes that do not fertilise or show abnormal fertilisation are not used for transfer.
Embryo development and transfer
The cleavage pattern of fertilised oocytes is monitored. Depending on embryo number and development, endometrial preparation and the medical plan, fresh transfer, extended blastocyst culture or freezing may be selected.
Commonly expected symptoms
- Mild pelvic discomfort after oocyte collection
- Light spotting
- Temporary bloating or tiredness
- Medication-related sensitivity
When to contact the clinic
- Worsening abdominal pain or marked abdominal swelling
- Heavy bleeding, fever or foul-smelling discharge
- Shortness of breath, feeling faint or rapid weight gain
- Signs of a severe allergic reaction to medication
Treatment schedule
How Long Does ICSI Treatment Take?
The ICSI laboratory procedure is carried out on the day of oocyte collection. The overall treatment duration varies according to the protocol, embryo development and whether a fresh or frozen embryo transfer is planned.
Initial assessment
Collection of investigations and preparation of an individual treatment plan.
VariableOvarian stimulation
Medication use and ultrasound monitoring.
Approximately 8–12 daysOocyte collection + ICSI
Oocytes are collected, sperm is prepared and microinjection is performed.
Same dayEmbryo monitoring
Fertilisation and development checks.
Usually 3–6 daysTransfer or freezing
The decision is made according to the endometrial and embryo plan.
IndividualisedPregnancy test
The clinic provides a date according to the type of embryo transfer.
On the specified dayInternational patients
How long do I need to stay in Cyprus?
If pre-treatment investigations and medication monitoring can be completed in your country of residence, the required stay in Cyprus may be shorter. Oocyte collection, embryo monitoring and transfer may take place during the same visit or on different dates. The exact schedule is prepared by the patient coordinator after your medical records have been reviewed.
Explore international patient coordination
Realistic expectations
What Factors Affect ICSI Treatment Outcomes?
ICSI supports the step in which sperm enters the oocyte. The final treatment outcome is influenced by the oocyte, sperm, embryo, uterus and the laboratory process as a whole.
Female age
With increasing age, both the number of oocytes and the likelihood of obtaining chromosomally suitable embryos may change.
Ovarian reserve and oocyte maturity
The number of mature oocytes suitable for ICSI is as important as the total number of oocytes collected.
Sperm characteristics
Availability of viable sperm, motility, morphology and the underlying cause of male infertility may affect the process.
Previous treatments
Fertilisation rates and embryo-development records provide important information for planning subsequent treatment.
Embryo development
After normal fertilisation, cleavage pattern, developmental rate and blastocyst formation are monitored.
Uterine factors
Endometrial preparation, intrauterine pathology and transfer timing may influence implantation.
Laboratory quality
Air quality, temperature, pH, gas conditions, equipment controls and embryologist expertise are important elements of the laboratory environment.
General health and lifestyle
Smoking, significant excess weight, uncontrolled medical conditions and some environmental factors may affect reproductive health.
Why is it important to interpret outcomes correctly?
Evidence of normal fertilisation in an injected mature oocyte.
Progression of the fertilised oocyte through appropriate cell division.
Identification of an intrauterine gestational sac on ultrasound.
A pregnancy resulting in the birth of a live baby.
These four outcomes are not the same. A laboratory fertilisation rate alone does not represent the probability of clinical pregnancy or live birth.
Personalised treatment planning
ICSI Treatment Costs
The cost of ICSI may include more than the microinjection procedure itself. The overall treatment scope varies according to investigations, medication protocol, sperm-retrieval method, embryo culture and additional laboratory requirements.
Main factors that may affect cost
- Initial assessment and required investigations
- Ovarian-stimulation medications
- Oocyte collection and anaesthesia
- ICSI laboratory procedure
- Embryo culture and monitoring duration
- Embryo freezing and storage
- Surgical sperm-retrieval procedures
- Genetic testing or embryo-biopsy plan
- Donor-gamete processes, when applicable
- International patient coordination
Embryology and quality
How Are Laboratory Processes and Technology Used During ICSI?
Successful laboratory practice in ICSI involves more than the movement of a micropipette. Correct identity tracking of cells, appropriate preparation of sperm and oocytes, equipment quality control and stability of the embryo-culture environment are all part of the process.
ICSI-specific quality pathway
A traceable process from sperm preparation through embryo monitoring
On the day of ICSI, the sperm sample is prepared, oocyte maturity is assessed and every suitable oocyte is processed at a micromanipulation workstation. After injection, the oocytes are returned to controlled incubator conditions and fertilisation assessment is scheduled.
- Identity verification and electronic witnessing provide an additional safety layer for tracking samples throughout the process.
- Regular quality control of microscopes, micromanipulators and incubators supports stable laboratory conditions.
- When EmbryoScope+ is used, embryo-development images can be monitored without repeatedly removing embryos from the incubator environment.
CAP-accredited laboratory approach
Laboratory processes are standardised across areas such as staff competency, equipment monitoring, quality control, documentation and traceability. The Ventus IVF Center Laboratory CAP certificate carries CAP number 9751707.
Chip-based identification and electronic witnessing
Designed to support verification of patient identity and continuity of records throughout sperm, oocyte and embryo procedures. It is used as an additional safety layer rather than as a replacement for human checks.
AI-assisted assessment
With appropriate systems, data derived from sperm or embryo images may be used to support embryologist judgement. Final selection remains an expert decision and does not guarantee an outcome.
Microfluidic sperm preparation
In clinically appropriate cases, microfluidic systems may be used during sperm preparation. They are not required for every patient and are considered separately from the decision to use ICSI.
EmbryoScope+ monitoring
Allows developing embryos after ICSI to be imaged at defined intervals, records developmental timing and supports embryologist assessment.
Air, gas and VOC control
Oocytes and embryos are sensitive to environmental changes. Control of filtration, pressure, temperature, gases, humidity and volatile organic compounds supports stability of the culture environment.
College of American Pathologists
Ventus IVF Center Laboratory — CAP# 9751707
The certificate states that the laboratory is accredited under the CAP Reproductive Laboratory Accreditation Program and indicates that reinspection is due before 8 October 2027.
Multidisciplinary team
Which Team Is Involved in ICSI Treatment?
The decision to use ICSI and its laboratory application are coordinated between the IVF specialist, scientific leadership and the embryology laboratory.
Treating physician
Assoc. Prof. Dr Beril Yüksel
Ventus IVF Clinical Director · Obstetrics, Gynaecology and IVF Specialist
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Scientific Director
Dr Münevver Serdaroğulları
Scientific processes, laboratory standards and quality approach
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Transparent information
What Are the Risks and Limitations of ICSI Treatment?
Although ICSI is an effective laboratory method for supporting fertilisation, it does not eliminate biological uncertainty. Individual risks and alternatives should be discussed before treatment.
Damage to the oocyte during injection
Although very fine pipettes are used, an oocyte can be damaged during injection and may no longer be suitable for use.
Only mature oocytes can be injected
Not every collected oocyte will necessarily be mature. The number of oocytes suitable for ICSI may therefore be lower than the total number collected.
Failure of fertilisation or abnormal fertilisation
Even when a sperm is placed inside the oocyte, normal fertilisation may not occur or development may stop at an early stage.
Underlying male factor infertility
Severe disorders of sperm production may have a genetic cause. Genetic counselling and testing may be recommended when appropriate.
Risks associated with the wider IVF process
Risks such as those associated with ovarian stimulation, oocyte collection, anaesthesia, embryo transfer and multiple pregnancy relate to the wider IVF treatment process.
No guarantee of outcome
ICSI can facilitate the fertilisation step; it cannot guarantee a good-quality embryo, pregnancy, healthy pregnancy or live birth.
Limitations of routine use
In patients without male factor infertility or previous fertilisation failure, routine ICSI has not been shown to increase live-birth rates.
Add-on methods do not automatically provide benefit
Methods such as IMSI, PICSI or other sperm-selection add-ons should not be assumed to be superior to standard ICSI for every patient; the evidence and individual indication should be considered.
Patient guide
Frequently Asked Questions About Intracytoplasmic Sperm Injection (ICSI)
We answer common questions about treatment decisions, the laboratory process, cost scope and planning a stay in Cyprus.
What is intracytoplasmic sperm injection (ICSI)?
ICSI is the placement of one selected sperm cell directly into a mature oocyte using a very fine microinjection pipette. Oocyte collection, embryo culture and embryo transfer continue within the overall IVF pathway; ICSI is the fertilisation method used in the laboratory.
What is the main difference between ICSI and conventional IVF?
In conventional IVF, prepared sperm cells are placed in the same culture environment as the oocytes and one sperm is expected to enter the oocyte independently. In ICSI, one selected sperm is injected directly into a mature oocyte.
Who may be offered ICSI?
It may be considered when there is markedly reduced sperm concentration, motility or morphology; when sperm has been surgically retrieved; when a previous IVF attempt resulted in no or very low fertilisation; or when warmed oocytes are being fertilised. The final decision is made after reviewing semen analysis, oocyte characteristics and previous treatment outcomes together.
Should ICSI be used for every IVF patient?
No. Current guidance does not show that routine ICSI increases the chance of live birth in every patient without male factor infertility or a previous fertilisation problem. The method should be selected according to clinical need.
Is ICSI painful?
Because ICSI is performed on oocytes in the laboratory, the patient does not feel the microinjection itself. The patient experiences ovarian stimulation, oocyte collection and, when applicable, embryo transfer; appropriate pain relief or anaesthesia is planned for these stages.
How long does the ICSI procedure take?
Although injection of an individual oocyte is brief, preparation, assessment of oocyte maturity and injection of all suitable oocytes can take several hours according to the laboratory programme. The overall treatment duration depends on ovarian stimulation, oocyte collection, embryo development and the transfer plan.
When is fertilisation assessed after ICSI?
Oocytes are usually assessed for normal fertilisation the day after injection. Fertilised oocytes are then monitored over the following days for embryo development.
Does every mature oocyte fertilise after ICSI?
No. ICSI helps bypass the barrier of sperm entry into the oocyte, but fertilisation may still not occur because of oocyte maturity, cellular characteristics, sperm factors and other biological processes.
What determines the chance of success with ICSI?
Outcomes depend on more than the microinjection technique. Female age, ovarian reserve and oocyte quality, number of mature oocytes, sperm characteristics, embryo development, uterine factors, laboratory processes and previous treatment history all contribute.
Is the fertilisation rate the same as the pregnancy rate?
No. Fertilisation refers to the oocyte and sperm combining and embryo development beginning. Clinical pregnancy refers to seeing a gestational sac on ultrasound, while live birth refers to a pregnancy resulting in a live-born baby. These outcomes should not be used interchangeably.
Can ICSI be performed with surgically retrieved sperm?
Yes. Suitable viable sperm retrieved by PESA, MESA, TESE or Micro-TESE may be used for ICSI. The retrieval method and whether sperm is used fresh or after freezing are planned by the urology and embryology teams.
Is ICSI used after frozen oocytes are warmed?
ICSI is a commonly established approach for fertilising warmed mature oocytes. Oocytes that survive warming and are considered suitable are assessed by the embryology team.
Can ICSI damage the oocyte?
Although the procedure is performed by experienced embryologists using very fine micropipettes, the risk of oocyte damage during injection cannot be reduced to zero. Only mature oocytes suitable for the procedure can be used.
Does ICSI increase the risk of genetic disease?
Some causes of male infertility may have a genetic basis and may potentially be inherited. In individual cases, it may not be possible to determine precisely how much observed risk relates to ICSI itself and how much relates to the underlying infertility. Genetic counselling and appropriate testing may be considered in severe male factor infertility.
When is embryo transfer performed after ICSI?
Depending on embryo development, number and quality, endometrial preparation and the clinical plan, a fresh transfer may be performed or embryos may be frozen for transfer in a later cycle. The transfer day is not the same for every patient.
How long do I need to stay in Cyprus for ICSI treatment?
The length of stay depends on whether the full treatment is carried out in Cyprus, whether preparation can be completed in your country of residence and whether a fresh or frozen transfer is planned. After you send your medical records, the patient coordinator can clarify an individual schedule.
What is included in the cost of ICSI?
The scope can vary according to the clinic and individual treatment plan. Ovarian stimulation and medication, oocyte collection, the ICSI laboratory procedure, embryo culture, freezing and storage, surgical sperm retrieval or genetic testing may be separate items. A written individual treatment plan should be requested.
When is the pregnancy test performed after ICSI?
The pregnancy test date is set by the clinic according to the embryo-transfer day and the protocol used. Because early home testing may be misleading, a blood beta-hCG measurement on the date provided by the clinic is generally preferred.
Related information
Treatments and Assessments Related to ICSI
An ICSI plan should be considered together with the other diagnostic and treatment stages of the IVF pathway.
Let’s make an individual decision
Let Us Assess the Need for ICSI Based on Your Medical Results
Send your semen analysis, hormone and ultrasound results and previous IVF reports. We can review why a particular fertilisation method may be recommended and help plan the treatment schedule and your travel to Cyprus.
- Review of current investigations and previous treatment records
- Individual ICSI / conventional IVF decision framework
- International patient coordination
Medical sources
This content was prepared with reference to the NICE 2026 recommendations on ICSI, the ASRM 2026 committee opinion and HFEA patient information to support an up-to-date clinical approach.