ICSI Treatment Abroad: Complete Guide to Intracytoplasmic Sperm Injection

What Is ICSI?

Intracytoplasmic Sperm Injection (ICSI) is a specialized fertilization technique where a single sperm is directly injected into the cytoplasm of a mature egg using a fine glass micro-needle. Developed in 1992, ICSI revolutionized the treatment of male factor infertility and has become the most widely used fertilization method in IVF — accounting for 70-80% of all IVF cycles worldwide. The procedure is performed by a skilled embryologist under a high-powered inverted microscope with micromanipulation equipment.

Before ICSI, men with severe sperm abnormalities — low count (oligozoospermia), poor motility (asthenozoospermia), abnormal morphology (teratozoospermia), or obstructive azoospermia — had very limited options for biological fatherhood. ICSI bypasses all barriers to natural fertilization by placing the sperm directly inside the egg, requiring only a single viable sperm per egg. This means that even men with extremely low sperm counts (as few as 1-2 sperm in the entire ejaculate, or sperm surgically retrieved from the testis or epididymis) can father genetically related children through ICSI.

When Is ICSI Recommended?

• Severe male factor infertility: Low sperm count (<5 million/mL), poor motility (<30% progressive), or abnormal morphology (<4% normal forms by strict criteria)
• Obstructive or non-obstructive azoospermia: Sperm retrieved surgically via TESE (testicular sperm extraction), micro-TESE, or PESA (percutaneous epididymal sperm aspiration)
• Previous IVF with poor or failed fertilization: If conventional IVF resulted in low fertilization rates (<50%) or complete fertilization failure
• Frozen sperm or surgically retrieved sperm: Thawed sperm often have reduced motility, making ICSI necessary
• PGT-A or PGT-M genetic testing: ICSI prevents contamination of genetic material from extra sperm attached to the egg surface
• Low egg yield: When few eggs are retrieved, ICSI maximizes the chance of fertilization for each egg
• Unexplained infertility with failed IUI cycles: ICSI may overcome subtle fertilization barriers not detected by standard tests

ICSI vs. Conventional IVF

In conventional IVF, approximately 50,000-100,000 prepared sperm are placed around each egg in a culture dish, and fertilization occurs naturally as a sperm penetrates the egg. In ICSI, the embryologist selects a single sperm, immobilizes it, and injects it directly into the egg's cytoplasm. The fertilization rate with ICSI is typically 70-85%, compared to 50-70% with conventional IVF — though this comparison is not entirely fair because ICSI is often used in cases where fertilization would be expected to be more difficult.

At leading Turkish IVF clinics, ICSI is included as standard in the IVF package at no additional cost — a significant advantage over US clinics, which typically charge $1,500-$3,000 extra for ICSI. Clinics like Bahçeci IVF Centre perform ICSI on virtually all IVF cycles, ensuring maximum fertilization rates regardless of sperm parameters. The Jinepol IVF Clinic employs dedicated ICSI embryologists who perform the procedure with exceptional precision, achieving fertilization rates consistently above 80%.

ICSI Cost Comparison

ICSI Treatment Cost Comparison 2025

Most Turkish IVF clinics include ICSI as standard in their IVF package at no additional cost. In the US and Europe, ICSI is often charged separately.

One of the most significant cost advantages of IVF abroad — particularly in Turkey — is that ICSI is typically included in the standard IVF package price. In the US, ICSI adds $1,500-$3,000 to the IVF bill, even though it is recommended for the majority of cycles. Turkish clinics like Adem & Havva Center and Memorial Şişli Hospital include ICSI as a routine component of their IVF packages, meaning patients pay the same price whether or not ICSI is needed — eliminating the uncertainty of unexpected add-on charges.

ICSI Success Rates

ICSI fertilization rates at experienced clinics are typically 70-85%, meaning that out of 10 mature eggs injected, 7-8.5 will fertilize normally. Live birth rates per ICSI cycle are comparable to conventional IVF — approximately 45-55% for women under 35 — as the primary determinant of success after fertilization is embryo quality, which is driven by egg quality (patient age) rather than the fertilization method.

For men with severe male factor infertility requiring surgically retrieved sperm (TESE/micro-TESE), success rates are somewhat lower — approximately 30-45% per cycle for women under 35 — because surgically retrieved sperm may be less mature. However, ICSI makes biological fatherhood possible in cases that were previously considered hopeless, and cumulative success rates over 2-3 cycles can reach 60-75% even with surgically retrieved sperm.

Advanced Sperm Selection

Several advanced sperm selection techniques can improve ICSI outcomes by identifying the healthiest sperm for injection. MACS (Magnetic Activated Cell Sorting) removes apoptotic (dying) sperm using magnetic antibody separation, improving embryo quality. IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) uses ultra-high magnification (6000-8000x vs. standard 200-400x) to select sperm with the most normal nuclear structure. Physiological ICSI (PICSI) selects mature sperm based on their ability to bind to hyaluronic acid, mimicking natural selection at the egg surface.

My husband was diagnosed with severe oligozoospermia — fewer than 1 million sperm per mL. We were told our only option was donor sperm or adoption. Then we found a clinic in Istanbul that specializes in ICSI with surgically retrieved sperm. Six months later, I was pregnant with our biological child. ICSI truly is a miracle of modern medicine.

Maria & Antonio L., treated in Turkey