Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: June 2026.
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
ICSI is performed in our in-house embryology lab by Senior Clinical Embryologist Aayush Agarwal, Ph.D., with treatment planned and overseen by Dr. Shweta Agarwal (MBBS, DGO). Because ICSI, IVF and embryo transfer are all done on-site, your eggs and embryos never leave our care — you can verify our government ART registration on the National ART & Surrogacy Registry. In vernacular, ICSI is sometimes referred to as इक्सी within "test tube baby" (टेस्ट ट्यूब बेबी) treatment.
How is ICSI different from standard IVF?
The difference is purely in how fertilisation happens — every other part of the cycle (stimulation, egg retrieval, embryo culture, transfer) is identical. In standard IVF, prepared sperm and eggs are placed together in a dish and fertilisation occurs naturally. In ICSI, the embryologist selects one healthy sperm and injects it directly into the centre of each mature egg, bypassing the barriers that prevent fertilisation.
| Standard IVF | ICSI | |
|---|---|---|
| Fertilisation | Sperm fertilise the egg on their own in a dish | One sperm injected into each egg manually |
| Best for | Tubal factor, mild male factor, unexplained | Severe male factor, prior fertilisation failure |
| Sperm needed | Many motile sperm | Very few viable sperm |
| Equipment | Standard incubation | Micromanipulator + high-magnification microscope |
ICSI does not improve egg quality, embryo quality, or the chance of implantation on its own — it improves the chance that an egg fertilises when sperm are the limiting factor. For couples without a sperm factor, standard IVF is equally appropriate, and ICSI is not added routinely.
Who needs ICSI?
ICSI is recommended when natural fertilisation in a dish is unlikely to succeed. Dr. Shweta Agarwal recommends it based on your fertility diagnostics — particularly the semen analysis — and your treatment history. The main indications are:
- Severe male-factor infertility — significantly low sperm count, poor motility, or abnormal morphology on semen analysis. (See male infertility.)
- Surgically retrieved sperm — when sperm are obtained directly from the testes or epididymis via TESA/PESA/TESE because of a blockage, previous vasectomy, or azoospermia (no sperm in the ejaculate).
- Previous fertilisation failure — when a prior standard IVF cycle resulted in poor or failed fertilisation.
- Frozen or limited eggs — frozen eggs develop a harder outer shell on thawing, and when only a few eggs are available, ICSI maximises the chance each one fertilises.
- Very low egg numbers — to make the most of each retrieved egg.
ICSI is a tool for a specific problem — fertilisation. It is recommended only when it offers a clear clinical benefit, not as a default for every patient.
How does the ICSI process work, step by step?
ICSI takes place within a full IVF cycle and follows the same overall timeline of about 4–6 weeks. The ICSI-specific step happens in the lab on the day of egg retrieval:
- Ovarian stimulation (Days 1–12): Daily hormone injections encourage the ovaries to mature multiple eggs, monitored by ultrasound and hormone tests.
- Egg retrieval: A minor procedure under IV sedation (~15–20 minutes) collects the mature eggs.
- Sperm preparation & selection: On the same day, the semen sample (or surgically retrieved sperm) is processed. Under high magnification, the embryologist selects individual healthy, motile sperm.
- The ICSI injection: Each mature egg is held in place with a fine holding pipette while a single selected sperm is injected directly into its centre using a microneedle and a micromanipulator. This is repeated for every mature egg.
- Fertilisation check: The next morning (~16–18 hours later), the eggs are examined for signs of normal fertilisation.
- Embryo culture (Days 1–5): Fertilised eggs develop in controlled incubators, often to the Day-5 blastocyst stage to aid embryo selection.
- Embryo transfer: One healthy embryo is transferred to the uterus under ultrasound guidance; surplus good-quality embryos can be frozen.
- Pregnancy test: A blood beta-hCG test 10–14 days after transfer.
The ICSI step itself is performed by Aayush Agarwal, Ph.D., Senior Clinical Embryologist, in our in-house lab, using precision micromanipulation equipment.
How is ICSI success actually measured?
The most direct measure of ICSI is the fertilisation rate — the proportion of injected mature eggs that fertilise normally. Published data generally place ICSI fertilisation in the region of 70–80% of injected mature eggs, though this varies with egg and sperm quality and is a general statistic, not a clinic-specific claim. A high fertilisation rate is the goal of the ICSI step itself.
Fertilisation, however, is not the same as a pregnancy. The chance of a pregnancy depends on egg quality, the woman's age, embryo quality, and uterine factors — exactly as it does in standard IVF. ICSI removes the fertilisation barrier; it does not change these other variables.
During your consultation, Dr. Shweta Agarwal will discuss realistic, age-appropriate expectations for your specific situation rather than a single headline figure.
What does ICSI cost?
ICSI is generally added to the cost of a standard IVF cycle because it requires specialised micromanipulation equipment and embryologist time to inject each egg individually. The total cost varies with your protocol, medications, whether blastocyst culture or freezing is included, and the number of cycles. You receive a transparent, written cost estimate before anything begins.
See /costs-emi for current pricing information. Final cost depends on individual clinical evaluation.
- 0% EMI options are available (3–24 months), so treatment can be paid monthly.
- See the IVF cost & 0% EMI page for a detailed breakdown of what is included, or estimate with our IVF cost & EMI calculator.
What are the risks of ICSI? (Being honest)
ICSI is a safe, well-established procedure, but a few points are discussed openly:
- Slightly higher rate of certain conditions: Some studies report a small increase in certain genetic or developmental conditions in ICSI babies compared with natural conception. Current evidence links much of this to the underlying cause of infertility (for example, severe male-factor genetics) rather than the injection itself. The large majority of ICSI babies are healthy.
- Egg damage: A small number of eggs may not survive the injection. This is expected and accounted for in planning.
- Failed fertilisation: Even with ICSI, not every injected egg fertilises, and rarely fertilisation may fail altogether.
- Shared IVF-cycle risks: Because ICSI is part of an IVF cycle, the cycle carries the usual IVF risks — ovarian hyperstimulation syndrome (OHSS), the small risks of egg retrieval, and multiple pregnancy if more than one embryo is transferred. See the IVF page for detail.
For couples with a significant sperm factor or known genetic concerns, genetic counselling and, where appropriate, preimplantation genetic testing (PGT) can be discussed before treatment.