ICSI stands for intracytoplasmic sperm injection. It is a lab technique used during IVF. In this technique, a single sperm is injected directly into each mature egg. You may need ICSI if there are issues with sperm count, movement, or shape. These problems can make it hard for sperm to fertilise an egg on their own.
ICSI vs Conventional IVF
What the Lab Does Differently
In conventional IVF, sperm and eggs are placed together in a dish. Fertilisation happens naturally when a sperm enters the egg. With ICSI, an embryologist chooses one healthy-looking sperm and injects it straight into the egg using a very fine needle. If fertilisation works, your embryo is grown and transferred or frozen just like in regular IVF. Everything after fertilisation is the same.
ICSI does not change your eggs. It will not improve egg quality, embryo grading, or the chance of implantation. It only changes how fertilisation happens.
Who Needs ICSI
Male Factor Infertility
ICSI is most often used when a male factor is involved. You may need ICSI if you have a low sperm count (oligospermia, fewer than 16 million sperm per millilitre), poor sperm movement (asthenospermia, below 42% moving sperm), or abnormal sperm shape (teratospermia, less than 4% normal forms). If sperm is collected through a surgical procedure like TESA or micro-TESE, ICSI is usually the only option because the number of sperm is very low.
Previous Fertilisation Failure
If you have had a previous IVF cycle where fertilisation did not work or was very low, even though the sperm looked normal, ICSI is usually recommended for your next cycle. This helps reduce the chance of the same problem happening again.
Frozen Eggs
If you are using frozen eggs, either your own or from a donor, ICSI is usually recommended. Freezing and thawing can make the egg’s outer shell (zona pellucida) harder, so sperm can’t get inside as easily.
PGT Cycles
If you are planning preimplantation genetic testing (PGT-A or PGT-M), ICSI is used to ensure accurate test results. This helps prevent residual sperm DNA from mixing with the embryo sample, which could affect the results.
Very Low Egg Numbers
If only a few mature eggs are collected, usually fewer than four, ICSI is often suggested. This gives you the best chance of fertilisation and helps avoid the disappointment of no eggs fertilising in a low-yield cycle.
Who Probably Does Not Need ICSI: Say This Clearly
ICSI is now used in most IVF cycles worldwide. But if you do not have male factor infertility, the evidence does not support using ICSI routinely. This is a key point that is often missed in fertility care.
Research indicates that when there is no male factor infertility, conventional IVF will give you a better opportunity of having a baby than ICSI. For instance, a big study found that conventional IVF resulted in higher live birth rates than ICSI in such cases. Other major analyses, such as the 2023 Cochrane review, also found that using ICSI provides no advantage when the sperm parameters are normal.
If your sperm parameters are normal, your previous fertilisation was good, you are not using frozen eggs, and you are not planning PGT, conventional IVF works just as well as ICSI. It also costs less and involves fewer lab steps. If your clinic suggests ICSI without one of these reasons, you can ask them to explain why.
Does ICSI Improve Your Embryo Quality or Success Rates? Here’s What You Need to Know
ICSI changes how fertilisation happens, but it does not improve your embryo’s natural quality. Your embryo quality depends mostly on the age and health of your eggs and the sperm’s genetic health.
Here’s something important for you to know: ICSI cannot fully fix problems caused by high sperm DNA fragmentation. If the sperm DNA fragmentation index is above 30%, pregnancy and live birth rates are still lower, even with ICSI. If you have had repeated IVF failures or unexplained poor embryo development, your doctor may recommend sperm DNA fragmentation testing before starting another ICSI cycle.
Fertilisation Rates With ICSI
ICSI usually leads to higher fertilisation rates per egg than conventional IVF. With ICSI, about 70 to 85% of mature eggs fertilise. With conventional IVF, this is about 60 to 75%. You may notice the biggest difference if you have fewer eggs or low sperm quality.
Keep in mind, a higher fertilisation rate does not always mean a higher chance of live birth. What matters most is embryo quality and how ready your uterus is for implantation. Fertilisation rate is a lab measurement. It does not predict pregnancy.
Risks and What the Long-Term Data Shows About Children Born After ICSI
ICSI has been used safely for over 30 years. For most people, the risks are similar to those of conventional IVF.
There are two areas you should know about:
Chromosomal abnormalities: A large 2026 review found that children born after ICSI had a slightly higher rate of chromosomal abnormalities than those born after conventional IVF (0.91% compared to 0.06%). The overall risk is still low. This difference is likely due to the genetic factors linked to severe male infertility, not the ICSI procedure itself.
Imprinting disorders: Conditions like Beckwith-Wiedemann syndrome and Angelman syndrome are a little more common after ART, including ICSI, than after natural conception. The risk is still less than 1%. There is no clear proof that ICSI itself causes these conditions. The higher rates may be linked to the underlying fertility issues, not the procedure.
These findings do not mean ICSI is unsafe. You deserve clear and honest information. Using ICSI when it is not needed adds a small extra risk without proven benefit.
Cost in Singapore
If you choose ICSI, you can expect to pay about SGD $1,000 to $3,000 more than a standard IVF cycle in Singapore. The total cost for a full cycle with ICSI usually ranges from SGD $12,000 to $22,000, depending on your clinic and whether you go to a public or private centre. You can use MediSave and government co-funding for ICSI, just like with IVF. This means you may claim up to SGD $6,000 from MediSave for your first cycle, and if you are an eligible Singapore Citizen couple at a public hospital, you may get up to 75% co-funding.
Where ICSI Is Offered in Singapore
ICSI can be carried out at any fertility clinic in Singapore which provides IVF treatment. This applies to public hospitals such as KKH, SGH, and NUH as well as to private clinics including Virtus Fertility Centre, Raffles Fertility Centre, Thomson Fertility Centre, and Alpha IVF. All of these centres have to obtain a licence from the Ministry of Health to operate as Assisted Reproduction centres. The centres differ in laboratory quality, embryologists’ experience, and post-thaw survival rates. It would be a good idea to ask your clinic about these points.
Questions to Ask Your Clinic
Before you go ahead with ICSI, here are some important questions you may want to ask your clinic:
- Ask your doctor why they recommend ICSI. If the reason is not male factor infertility, previous fertilisation failure, frozen eggs, or PGT, ask them to explain the evidence behind their recommendation.
- If you are planning TESA or micro-TESE, ask your clinic about their post-thaw sperm survival rate for surgically retrieved sperm.
- Check if your partner’s sperm DNA fragmentation has been tested. High DNA fragmentation can affect your chances of success, even with ICSI.
- Ask if PICSI is available at your clinic. This technique uses hyaluronic acid to help select sperm with lower DNA fragmentation. According to the HFEA, there is limited but promising evidence that PICSI may help reduce miscarriage rates in cases with high DNA fragmentation.
- Ask your clinic about their ICSI fertilisation rate. A good laboratory usually achieves fertilisation in 70 to 85% of mature eggs with ICSI.
Frequently Asked Questions
References:
- Cutting, E., Horta, F., Dang, V., van Rumste, M. M., & Mol, B. W. J. (2023). Intracytoplasmic sperm injection versus conventional in vitro fertilisation in couples with males presenting with normal total sperm count and motility. The Cochrane Database of Systematic Reviews, 8(8), CD001301. https://doi.org/10.1002/14651858.CD001301.pub2
- Ferraro, Z. M., Meng, L., Liu, K. E., Greenblatt, E. M., & Russo, M. A. (2026). Intracytoplasmic sperm injection for non-male factor infertility does not improve cumulative live birth rate: A Canadian assisted reproductive technologies registry (CARTR Plus) descriptive study. Frontiers in Reproductive Health, 8, 1822305. https://doi.org/10.3389/frph.2026.1822305
- Gambadauro, A., Chirico, V., Galletta, F., Gulino, F., Chimenz, R., Serraino, G., Rulli, I., Manganaro, A., Gitto, E., & Marseglia, L. (2025). Imprinting Disorders and Epigenetic Alterations in Children Conceived by Assisted Reproductive Technologies: Mechanisms, Clinical Outcomes, and Prenatal Diagnosis. Genes, 16(10), 1242. https://doi.org/10.3390/genes16101242
- HFEA: UK fertility regulator. (n.d.). Human Fertilisation & Embryology Authority (HFEA). Retrieved 27 September 2026, from https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/
- Le, T. P. A., Loh, E.-W., Lai, T.-J., & Tam, K.-W. (2026). Health and development of children conceived using assisted reproductive technology: A meta-analysis of real-world data. Reproductive Biomedicine Online, 53(4), 105837. https://doi.org/10.1016/j.rbmo.2026.105837
- Paffoni, A., Vitagliano, A., Corti, L., Somigliana, E., & Viganò, P. (2024). Intracytoplasmic sperm injection versus conventional in vitro insemination in couples with non-male infertility factor in the ‘real-world’ setting: Analysis of the HFEA registry. Journal of Translational Medicine, 22(1), 687. https://doi.org/10.1186/s12967-024-05515-x
Reviewed By
Dr. Rabia kakatikar
Embryologist
Dr. Rutuja Raundal
Gynaecologist/Fertility Specialist
Cosmetic Gynaecologist
Anna Haotanto is the Founder of Zora Health and a passionate advocate for women’s empowerment. Anna’s personal experiences with egg-freezing, PCOS, perimenopause and the challenges of fertility have fueled her mission to provide high-quality information, financing, and support to help women and couples navigate their fertility journeys with confidence. She is also recognised for her achievements in finance, entrepreneurship, and women’s empowerment, and has been featured in various media outlets. You can also follow her on Linkedin or Instagram.
