When is ICSI recommended for male factor infertility?

ICSI is a laboratory fertility technique in which an embryologist places a single sperm into an egg. It can be considered when sperm have difficulty reaching or entering an egg during conventional IVF, when only a small number of sperm are available, or when sperm are obtained through a procedure rather than ejaculation. It may also be discussed after a previous IVF cycle produced little or no fertilisation. The choice depends on both partners’ assessment.

A fertility team will usually review semen analyses, previous treatment, the source of the sperm, and the number and maturity of eggs expected. Repeat testing may help confirm whether the finding persists. Ask how sperm will be collected, whether genetic or hormonal assessment is relevant, and what alternatives are suitable. Take prescribed medicines as directed and tell the team about supplements or treatments already being used.

Arrange a fertility assessment when pregnancy has not occurred despite regular attempts, or sooner when there is a known testicular problem, prior chemotherapy, surgery affecting sperm production, or difficulty with ejaculation. Seek urgent care for sudden severe testicular pain or swelling. These symptoms need separate medical assessment and should not wait for a fertility appointment.

Which sperm findings support ICSI in our situation? Is another semen test needed? How will sperm be obtained if ejaculation is difficult? What happens if no usable sperm are found?