Quality statement 7: Intracytoplasmic sperm injection

Quality statement

Women having in vitro fertilisation (IVF) are offered intracytoplasmic sperm injection (ICSI) only if there are severe deficits in semen quality, obstructive azoospermia, non‑obstructive azoospermia or if previous IVF treatment resulted in failed or very poor fertilisation.

Rationale

ICSI is a technique in which a single sperm is injected into an egg to achieve fertilisation. It is sometimes used in addition to IVF and improves the chances of conception. However, given the added resources involved, its use should be determined by clinical need.

Quality measures

Structure

Evidence of local arrangements to ensure that ICSI is offered only if there are severe deficits in semen quality, obstructive azoospermia, non‑obstructive azoospermia or if previous IVF treatment resulted in failed or very poor fertilisation.

Data source: Local data collection.

Process

Proportion of women having IVF with ICSI because of severe deficits in semen quality, obstructive azoospermia, non‑obstructive azoospermia or because previous IVF treatment resulted in failed or very poor fertilisation.

Numerator – the number in the denominator having ICSI because of severe deficits in semen quality, obstructive azoospermia, non‑obstructive azoospermia or because previous IVF treatment resulted in failed or very poor fertilisation.

Denominator – the number of women having IVF with ICSI.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (specialist fertility services) ensure that policies are in place to offer ICSI to women having IVF only if there are severe deficits in semen quality, obstructive azoospermia, non‑obstructive azoospermia or if previous IVF treatment resulted in failed or very poor fertilisation.

Healthcare professionals (in specialist fertility services) offer ICSI to women having IVF only if there are severe deficits in semen quality, obstructive azoospermia, non‑obstructive azoospermia or if previous IVF treatment resulted in failed or very poor fertilisation.

Commissioners (clinical commissioning groups) monitor the use of ICSI for women having IVF in the services they commission.

What the quality statement means for patients

Women having IVF are offered an additional procedure to improve their chances of getting pregnant only if problems with the sperm mean that it is unlikely to fertilise the egg without it, or if there was poor or no fertilisation with IVF in the past. The procedure involves injecting a sperm directly into the egg and is called intracytoplasmic sperm injection (ICSI for short).

Source guidance

  • Fertility (2013) NICE guideline CG156, recommendation 1.13.1.1.

Definitions of terms used in this quality statement

Severe deficits in semen quality

Low quality sperm identified through comparison of sperm analysis results to the reference values in the World Health Organization laboratory manual. [Expert opinion]

Intracytoplasmic sperm injection (ICSI)

A procedure sometimes used in addition to IVF, which involves injecting a single sperm into the inner cellular structure of an egg. [Fertility (NICE guideline CG156)]

Non‑obstructive azoospermia

No sperm in the ejaculate due to testicular failure. [Adapted from Fertility (NICE guideline CG156)]

Obstructive azoospermia

The testes produce sperm as normal but a blockage prevents entry to the ejaculate. [Adapted from Fertility (NICE guideline CG156)]