What’s the difference between IVF and ICSI and what’s best for you?

If you’re exploring your options to help you become a parent, you’ve likely come across the terms IVF and ICSI. But what’s the real difference between IVF and ICSI and is one more successful than the other? In this article, we answer all of your burning questions about these fertility treatments to help you understand what to expect and choose the one that’s right for you.

What happens during IVF?

During in vitro fertilization (IVF), most of the time you take medication to make your ovaries produce several follicles. Follicles are small sacs filled with fluid containing eggs which have the potential to get released during ovulation. Fertility doctors check when the follicles are ready to be retrieved using ultrasounds and blood tests. Once the follicles are mature enough, a healthcare provider retrieves them using an ultrasound and thin needle. This is mostly done under anesthesia.

In a lab, embryologists check if each follicle contains an egg. Then each egg gets combined with 50,000 or more swimming sperm in a petri dish. If fertilization is successful, the embryo(s) will develop over a few days while being monitored by a specialist called an embryologist. Your providers will then choose the best embryos (up to 2) to transfer to the womb.

What is ICSI? What is the difference between IVF and ICSI?

ICSI stands for intracytoplasmic sperm injection. It’s not actually a different treatment from IVF, but rather an additional step in the process. Once the eggs are retrieved, instead of being combined in the dish and waiting for a sperm to find its way to the egg on its own, an embryologist selects a single sperm and injects it directly into the egg. As this step takes place in the lab, you wouldn’t notice any change in your treatment compared to a conventional IVF cycle. Once the embryo has developed enough, a doctor transfers it to the womb in the same way as IVF.

Why is ICSI used?

ICSI is used to increase the chances of fertilization when it’s less likely due to any of the following factors:

• Very low sperm count
• Reduced sperm mobility
• Misshapen sperm
• Sperm has been physically retrieved rather than ejaculated due to blockages in the male reproductive tract
• Previous IVF cycle failed because fertilization was unsuccessful
• Using frozen sperm or eggs
• In vitro matured eggs are being used

In a nutshell, ICSI is mainly used to treat male factor infertility, while conventional IVF is chosen when there is a female cause of infertility or unexplained infertility.

Is ICSI more successful than conventional IVF?

The chances of having a baby through conventional IVF and ICSI depend on several factors, including your age and the reason behind your and/or your partner’s fertility struggles. Overall, ICSI does not improve the chances of a successful pregnancy compared to conventional IVF. Research shows that ICSI has proven to be helpful for fertilization only when there is male factor infertility.

According to the American Society for Reproductive Medicine, 50%-80% of eggs get fertilized through ICSI. But fertilization is just one piece of the puzzle. There are several other steps involved: the egg needs to develop into an embryo, implant properly in the womb, and grow. During ICSI, there’s also a chance that the eggs can be damaged from being punctured with the needle during fertilization.

Some people want to try ICSI even when there’s no male cause of infertility or when the woman is over the age of 40 in the hopes that it will improve the chances of success, and clinics around the world have been using it more and more. But research from 2017 published in the Journal of Human Reproduction and from 2021 in The Lancet
show that when male fertility is normal, ICSI is not more successful than conventional IVF.

Per embryo transfer (including both IVF and ICSI) the German IVF-Registry reports that in 2020, there was a live birth rate of 22.2%. This may sound a little low at first, but when you consider that the probability for a 25-year-old woman to get pregnant on a given cycle without any medical help averages at 23%, it looks a bit better! 35-year-old women have a 16% chance of getting pregnant per normal cycle without help.

Cost of IVF vs. ICSI

Cost is also a factor to consider when thinking about conventional IVF or ICSI. In Germany, an IVF cycle costs around 4,000 euros, while IVF with ICSI is around 6,000 euros total without medication (which is around 750 euros). The final costs per cycle can vary and depend on the actual number of eggs retrieved. Statutory health insurance companies cover half of the cost of the first three transfers for married couples up to a certain age, while some private companies may cover more.

In the U.S., pricing of fertility treatments and insurance coverage can vary a lot state-to-state. An average IVF cycle can be upwards of $12,000, which doesn’t include the cost for medications. ICSI treatment can be an additional $1,000-$2,500.

What are the risks?

In general, IVF and ICSI are safe medical procedures and complications are quite rare. The vast majority of children born thanks to these treatments develop totally normally. But there are a couple health impacts that may arise as a result of this treatment, including:

• Ovarian hyperstimulation syndrome (OHSS): Up to 5% of the time, the ovaries may not respond well to the medication, causing them to swell and become painful.
• Multiple birth: When more than one embryo is transferred, it’s possible to get pregnant with more than one baby, which carries some increased risks during pregnancy.
• Slightly increased risk of birth defects with IVF and ICSI compared to babies conceived naturally: 7.1% and 9.9% versus 5.7%, respectively. Experts believe this to be due to subfertility of the parents rather than the treatment itself.
• Slightly increased risk of health conditions including Beckwith-Wiedemann syndrome, Angelman syndrome, hypospadias, or sex chromosome abnormalities with ICSI.
• Slightly increased risk of premature birth and low birth weight.

Research shows no difference in the overall quality of the embryos created through ICSI compared to traditional IVF embryos.

Takeaway

IVF and ICSI are both well-researched and widely used techniques to help couples achieve their dream of becoming parents. ICSI is usually chosen when there is male-factor infertility at play, to increase the chances that fertilization will be successful. The choice of fertility treatment depends completely on what’s behind your struggle to conceive.

We at LEVY are passionate about helping people along their journey to parenthood by finding the root cause of infertility in the shortest possible time. Once we find out why you’re not getting pregnant, we’ll design a personalized treatment plan to increase your chances of a successful pregnancy.

Sources:

Dang et al.: Intracytoplasmatic sperm injection versus conventional in-vitro fertilisation in couples with infertility in whom the male partner has normal total sperm count and motility: an open-label, randomised controlled trial. THE LANCET. 2021;397(10284):1554-1563.

Boulet et al. Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection. JAMA. 2015;313(3):255-63.

Tannus et al.: The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age. Hum Reprod. 2017;32(1):119-124.

IVF und ICSI in München: So funktioniert die künstliche Befruchtung. Die Kinderwunschärtzin. Accessed 24 March 2022.

Assisted reproductive technology – IVF and ICSI. Better Health channel from the Department of Health, State Government of Victoria, Australia. 

Eftekhar M et al.: Comparison of conventional IVF versus ICSI in non-male factor, normoresponder patients. Iran J Reprod Med. 2012;10(2):131-136. 

How does ICSI differ to IVF? Complete Fertility. Accessed 24 March 2022. 

Assisted Reproductive Technologies. American Society for Reproductive Medicine. Accessed 24 March 2022. 

Bartnitzky S et al.: DIR Annual 2020 – The German IVF Registry. Journal of Reproductive Medicine and Endocrinology. 2021;5:205-247.

ART and Intracytoplasmic Sperm Injection (ICSI) in the United States. Centers for Disease Control and Prevention. Accessed 25 March 2022.

Ovarian hyperstimulation syndrome. Mayo Clinic. Accessed 25 March 2022.

In vitro fertilization (IVF). Mayo Clinic. Accessed 25 March 2022.

What is intracytoplasmic sperm injection (ICSI)? Fact Sheet From ReproductiveFacts.org, from the American Society for Reproductive Medicine.

Is In Vitro Fertilization Expensive? ReproductiveFacts.org from the American Society for Reproductive Medicine. Accessed 27 July 2022.

How Much Does IVF Really Cost? Verywell Family. Accessed 27 July 2022.

Davies MJ et al.: Maternal factors and the risk of birth defects after IVF and ICSI: a whole of population cohort study. BJOG. 2017;124(10):1537-1544.

Die künstliche Befruchtung optimal finanzieren. Stiftung Warentest. Accessed 04 August 2022.