ICSI - Circumventing Male Infertility

The Cleveland Clinic Urology Department's comprehensive male infertility service is one of a few in the United States offering intracytoplasmic sperm injection (ICSI) for men whose only hope for fatherhood previously had been donor insemination or adoption.

ICSI, pioneered over the last three years in Belgium, has been available in the United States only in the last two years. At the Cleveland Clinic, 62 percent of oocytes have been fertilized through ICSI, resulting in embryos for all couples and a pregnancy rate exceeding 40 percent per embryo transfer for the first six months of this year.

The procedure is indicated for men thought to be azoospermic who are found to have sperm present on centrifugation of a semen sample, and for men with severe oligospermia (less than 1 million sperm/mL), severe asthenospermia (low motility), or teratozoospermia (morphological abnormalities).

The process must be performed in conjunction with ovulation induction, and therefore requires close collaboration with Clinic gynecologists. A collegial, cooperative relationship among Clinic urologists, embryologists and gynecologists is essential for success.

Insertion of One Sperm inside the ovum through intracytoplasmic sperm injection (ICSI).


Congenital absence of the vas deferens with only caput epididymis present. Microsurgical epididymal sperm aspiration performed.

One of the greatest benefits of this new science is that only a single sperm per oocyte is required. Sperm are retrieved either from an ejaculated semen sample, through microsurgical aspiration from the epididymis or directly from the testis, where sperm is literally shaken loose from testicular material. The sperm sample is then cleansed and processed.

Simultaneously, between 10 and 20 oocytes are aspirated via the transvaginal route by the gynecologist. Harvested viable sperm and oocytes are then transferred to the laboratory of embryologist Kurt F. Miller, Ph.D.. Under sterile conditions, he uses an extremely fine needle under an operating microscope with micromanipulative capabilities to penetrate the zona pellucida and insert a single spermatozoa into each oocyte. After 24 hours, the oocytes are examined for fertilization.

After 48 to 72 hours, three to four embryos are transferred to the woman by the gynecologist. Surplus fertilized oocytes can be cryopreserved, if the couple wishes, for future attempts at establishing pregnancy. Extra sperm are also cryopreserved in our Andrology Laboratory and Sperm Bank, under the direction of Ashok Agarwal, Ph.D., to avoid repeat retrieval procedures.

A portion of men with azoospermia or oligospermia have irreparable congenital obstructions, most commonly congenital absence of the vas deferens. An estimated 75 percent of men with congenital absence of the vas deferens have an associated gene mutation for cystic fibrosis. Both husband and wife undergo genetic testing and counseling to help them decide whether they should proceed with an attempt at biological parenthood.

While the rate of fetal anomaly associated with ICSI remains controversial, most reports state that the rate is no higher or only slightly higher than that of the normal population. Both gynecologists and urologists thoroughly discuss these and other issues with patients prior to beginning the ICSI process.

In addition to multidisciplinary cooperation, the program's strength is based upon experience: Our team has ascended the steep learning curve associated with ICSI and has achieved success.

For more Information, or to refer a patient, please call Dr. Anthony Thomas at 216/444-6340.

The Cleveland Clinic Andrology Laboratory and Sperm Bank is accredited by the Commission on Laboratory Accreditation of the College of American Pathologists, in cooperation with the American Fertility Society.

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Last Update : December 30, 2008
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American Center for Reproductive Medicine
The Cleveland Clinic
10681 Carnegie Avenue, X11
Cleveland, OH 44195 USA
Tel: (216) 444-9485
Fax: (216) 445-6049