INDICATIONS FOR INTRACYTOPLASMIC SPERM INJECTION

Intracytoplasmic sperm injection (ICSI) is the latest of several micro fertilization techniques that have been utilized predominantly to over come severe male subfertility, giving fertilization and term pregnancy rates similar to conventional in-vitro fertilization (IVF) (but for o ther indications). Even though available data on children born after I CSI are very encouraging, the procedure must still be considered as no vel and the safety aspect to a great extent unexplored. In our opinion , therefore, ICSI should only be used for specific indications, and in this communication the non-existent, relative and absolute indication s for performing ICSI are outlined and discussed. With an apparently n ormal sperm sample, ICSI should not be used in a first cycle even if o nly few oocytes are obtained. When there is reason to suspect poor fer tilization, ICSI can be used in combination with conventional IVF in a split cycle. This includes cases of 'subnormal' sperm samples, high t itres of antisperm antibodies, or following a single cycle of poor fer tilization using conventional NF. Absolute indications for ICSI includ e two previous fertilization failures with conventional IVF, use of ep idiymal or testicular sperm samples, or when only acrosomeless or immo tile spermatozoa are available. The fertilization of oocytes prior to preimplantation genetic diagnosis is another absolute indication. It i s, however, important to keep in mind that for this novel technique, i ndications should not be rigid, but remain variable with respect to ne w findings.