Intracytoplasmic sperm injection
For some men, their sperm are not capable of fertilising eggs in the usual way. If this is the case, you and your partner may be offered a procedure called intracytoplasmic sperm injection (ICSI), in which a single sperm is injected directly into an egg.
You should only be offered ICSI if:
there are few sperm in your semen or they are of poor quality or
there are no sperm in your semen (either because of a blockage or another cause) but there are sperm in your testes which can be recovered surgically or
you have already tried IVF but there was poor or no fertilisation of the eggs.
In these situations, ICSI increases the chance of fertilising eggs compared with IVF used on its own. However, it doesn't make any difference to whether this will lead to a successful pregnancy.
If you are not able to ejaculate it is possible to obtain your sperm using surgical sperm recovery. You should be offered the chance to freeze some of your sperm for possible use later.
Before you consider ICSI, your doctor should offer both of you appropriate tests and discuss the results and their implications with you. They should also consider whether a genetic problem could be affecting sperm production. For some men, fertility problems result from a gene defect on their Y chromosome (the male sex chromosome). If your doctor knows or suspects that you have a specific gene defect they should offer you appropriate genetic counselling and tests.
If your sperm quality is very poor or you don't have sperm in your semen because of problems with sperm production, you should be offered a test known as karyotyping. This checks for abnormalities in your chromosomes. You should be offered genetic counselling about the possible results of this test.