ICSI PROCEDURE EMBRYO IMAGE EMBRYO TRANSFER In order to perform ICSI insemination, the cumulus complex of the egg is removed and the egg maturity and quality are evaluated. Maturity of the oocyte is important because only mature eggs have the opportunity to fertilize. ICSI involves the insertion of a single sperm directly into the cytoplasm of a mature egg. ICSI is typically recommended if a patient has one or more of the following: Male factor Diminished ovarian reserve Advanced maternal age Previous poor fertilization results from standard insemination Male Infertility Treatments The importance of a thorough evaluation of both partners in the relationship cannot be overestimated. Male factors account for at least 30 to 50 percent of all fertility issues in patients. Semen Analysis The semen analysis is done on an ejaculated sample collected after masturbation. It is best to do this test after a patient has abstained from sexual activity for two to five days. The test can be inaccurate if there has been recent ejaculation (counts too low) or if ejaculation has not occurred in a long time (many dead sperm). Once the sample has been taken to the laboratory, it is analyzed for many different parameters, including fluid volume, sperm numbers, sperm motility (the percentage of moving sperm), and sperm morphology (the shape and appearance of the sperm). Variations can occur from test to test, even in the same man, and sometimes the test needs to be repeated. Varicocele A urologist often is consulted after an abnormal semen analysis is obtained. The most common abnormality discovered by the urologist is a "varicocele." A varicocele is a dilated vein around the testicle, which raises the core temperature of the testicle and can impair the process of making sperm. The correction of a varicocele involves a minor surgical procedure. The procedure ligates the dilated vein, which improves blood flow around the testicle. Sperm Retrieval When a man has little to no sperm in his ejaculate, it may be possible to retrieve sperm from his testicles or epididymis. This is a procedure performed by a urologist. The sperm retrieved can either be frozen for future use or used immediately for an IVF cycle.