Intracytoplasmic Sperm Injection Outcomes in Male Infertility Treatment
Summary
Intracytoplasmic sperm injection (ICSI) has transformed the management of male infertility by enabling fertilisation in cases of severe oligozoospermia, asthenozoospermia and azoospermia. Its application extends from ejaculated sperm with low motility or abnormal morphology to surgically retrieved spermatozoa obtained by percutaneous epididymal sperm aspiration (PESA) or testicular sperm aspiration (TESA). Key outcome measures include fertilisation rate, embryo quality, implantation rate, clinical pregnancy and live birth. Sperm source and intrinsic sperm parameters such as DNA fragmentation index (DFI) influence embryo development, aneuploidy rates and morphokinetic progression. Advances in sperm selection techniques and cryopreservation protocols for individual sperm have further refined success rates, while long-term follow-up of offspring has allayed concerns regarding congenital anomalies. Global multi-centre data underscore the robustness of ICSI programmes across diverse healthcare settings, emphasising its pivotal role in assisted reproductive technology (ART) and its contribution to parenthood where conventional insemination proves inadequate.
Research from Nature Portfolio
Updated meta-analysis comparing testicular and ejaculated sperm in cryptozoospermic men indicates that fresh testicular sperm confer higher rates of good-quality embryos, implantation and clinical pregnancy. This synthesis of six comparative studies involving over 750 ICSI cycles demonstrates a consistent advantage of testicular sperm in overcoming severe sperm defects and optimising early embryonic competence.
A decade-long observational study of neonatal outcomes following ICSI with epididymal or testicular sperm reports comparable rates of congenital malformations to those seen with ejaculated sperm. Notably, clinical pregnancy and live birth rates were significantly elevated in non-ejaculated sperm cohorts, reinforcing the safety and efficacy of surgical sperm retrieval in ART practice.
Intracytoplasmic Sperm Injection Outcomes in Male Infertility Treatment publication trend
The graph below shows the total number of articles in intracytoplasmic sperm injection outcomes in male infertility treatment across all publications each year (not limited to Nature Index journals).
Technical terms
Intracytoplasmic sperm injection (ICSI): A micromanipulation technique in which a single sperm is injected directly into the cytoplasm of an oocyte to achieve fertilisation.
Cryptozoospermia: An extreme form of oligozoospermia characterised by very low sperm counts detectable only after centrifugation of the ejaculate.
DNA fragmentation index (DFI): A measure of the proportion of spermatozoa exhibiting breaks in nuclear DNA strands, reflective of sperm genomic integrity.
Aneuploidy: The presence of an abnormal number of chromosomes in the embryo, often assessed by preimplantation genetic testing.
Embryo morphokinetics: The timing and sequence of key developmental milestones in embryo cleavage and compaction, monitored by time-lapse microscopy.
Percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA): Minimally invasive surgical techniques to retrieve spermatozoa directly from the epididymis or testicular tissue, respectively, for use in ICSI.
References
- Intracytoplasmic Sperm Injection (ICSI) in Extreme Cases of Male Infertility. PLOS ONE (2014).
- Sperm retrieval techniques for assisted reproduction. International braz j urol (2011).
- Correlation study of male semen parameters and embryo aneuploidy in preimplantation genetic testing for aneuploidy. Frontiers in Endocrinology (2023).
- Cryopreservation of single-sperm: where are we today?. Reproductive Biology and Endocrinology (2020).
- A Novel Nanomaterial-Based Approach for the Cryopreservation of Individual Sperm Cells Using Addressable Nanoliter Containers. Nanomaterials (2025).
- Testicular sperm is superior to ejaculated sperm for ICSI in cryptozoospermia: An update systematic review and meta-analysis. Scientific Reports (2018).
- Neonatal outcome of children born after ICSI with epididymal or testicular sperm: A 10-year study in China. Scientific Reports (2020).
- Azoospermia and embryo morphokinetics: testicular sperm-derived embryos exhibit delays in early cell cycle events and increased arrest prior to compaction. Journal of Assisted Reproduction and Genetics (2018).
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