Quality statement 7: Intracytoplasmic sperm injection
Quality statement
Women, trans men and non-binary people with female reproductive organs are offered intracytoplasmic sperm injection (ICSI) only if surgically retrieved sperm or frozen-thawed oocytes are being used, there are abnormal semen parameters, or previous in vitro fertilisation (IVF) treatment resulted in failed fertilisation or a very low fertilisation rate. [2014, updated 2026]
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
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of women, trans men and non-binary people with female reproductive organs having ICSI because surgically retrieved sperm or frozen-thawed oocytes are being used, there are abnormal semen parameters or previous IVF treatment resulted in failed fertilisation or a very low fertilisation rate.
Numerator – the number in the denominator having ICSI because surgically retrieved sperm or frozen-thawed oocytes are being used, there are abnormal semen parameters or previous IVF treatment resulted in failed fertilisation or a very low fertilisation rate.
Denominator – the number of women, trans men and non-binary people with female reproductive organs having ICSI.
Data source: National data on provision of IVF and ICSI are available from the Human Fertilisation and Embryology Authority. Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (specialist fertility services) ensure that policies are in place to only offer ICSI to women, trans men and non-binary people with female reproductive organs because surgically retrieved sperm or frozen-thawed oocytes are being used, there are abnormal semen parameters or previous IVF treatment resulted in failed fertilisation or a very low fertilisation rate.
Healthcare professionals (in specialist fertility services) offer ICSI to women, trans men and non-binary people with female reproductive organs only because surgically retrieved sperm or frozen-thawed oocytes are being used, there are abnormal semen parameters or previous IVF treatment resulted in failed fertilisation or a very low fertilisation rate.
Commissioners monitor the use of ICSI for women, trans men and non-binary people with female reproductive organs in the services they commission.
Women, trans men and non-binary people with female reproductive organs having IVF are only offered an additional procedure to improve their chances of getting pregnant if surgically retrieved sperm or frozen-thawed oocytes are being used, or if problems with the sperm mean that it is unlikely to fertilise the egg without it, or there was very low fertilisation 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 problems: assessment and treatment. NICE guideline NG257 (2026), recommendations 1.50.1 to 1.50.3
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)
ICSI is a procedure where a live sperm is injected into the cytoplasm of an egg in a laboratory to fertilise the egg. It is commonly used in IVF for male factor fertility problems to overcome low sperm count. [NICE's guideline on fertility problems, evidence review L introduction]