The main concern with ICSI, is the selection of sperm. In nature, the strongest and healthiest sperm will be the most successful in reaching the egg first, ensuring the best possible communication of genetic material. However, in this technique, the sperm is selected in the laboratory and may not be the strongest. This is particularly the case where there is limited choice due to a low sperm count or a high proportion of morphologically abnormal sperm. The risks of passing on congenital defects are therefore higher than with normal conception, and patients may wish to consider pre-implantation genetic diagnosis (PGD) to screen for these before they proceed.
A further factor to consider is that if the father’s fertility problems are genetic, then there is a high risk of passing this on to the child.
As the procedure is done as part of the IVF cycle, the same risks also apply, including multiple births, problems with over-stimulation of the ovaries, and an increased risk of ectopic pregnancy.
The costs of ICSI undertaken privately will add up to £1,000 to the cost of IVF treatment (which are between £1,000 and £4,000 per cycle, depending on the clinic involved). The method of sperm retrieval will also affect the overall cost, especially where direct extraction from the testes is involved.
There may be the opportunity to have ICSI as part of IVF treatment on the NHS, but this varies between local health authorities, and will depend on the age and circumstances of the prospective patient.