Its been 30 Years: Let’s Talk About the Truth Behind This Popular Fertility Technique. Imagine being told you can’t have children—then discovering a little-known technique where a single sperm is injected directly into an egg, giving you a real shot at becoming a parent. That’s what Intracytoplasmic Sperm Injection, or ICSI, offered when it first hit the scene 30 years ago. It was revolutionary. And for millions of couples, it still is.

But fast-forward to today, and we’re left wondering: Is ICSI now being overused—even when it’s not needed?

A Groundbreaking Technique—Born for Male Infertility

ICSI emerged in the early 1990s as a lifeline for couples struggling with male factor infertility. The method involves injecting a single sperm directly into an egg, bypassing many natural barriers that may prevent fertilization. The result? Successful pregnancies for men who previously had very few options.

It quickly gained popularity across Europe, Australia, and around the world—and rightly so. It was a breakthrough.

From Specialized Use to Everyday Default?

Fast-forward to today, and ICSI is used in a large percentage of IVF cycles globally—often even when there’s no diagnosed sperm issue. In countries like Australia, ICSI rates can range from 30% to 90%, depending on the clinic or region.At The Fertilis Academy, this raises a key concern for fertility professionals-in-training:
If male infertility only accounts for roughly one-third of fertility cases, why is ICSI used in most cycles?

The Core Debate: Benefit vs. Necessity

Arguments for ICSI:

• Reduces risk of fertilization failure.
  
• Provides control when sperm quality is uncertain.
  
• May uncover hidden sperm issues not seen in basic analysis.
• Helps evaluate the oocytes for maturity and abnormalities
  

 Arguments Against Routine Use:

• No proven increase in live birth rates for non-male factor infertility.
  
• More expensive and technically demanding.
  
• Eliminates natural sperm selection—possibly affecting embryo quality.
  
• Long-term safety is still under review.
  

There’s a growing concern that ICSI might be becoming a reflex, not a reasoned decision.

What About the Babies?

Most studies show that children born through ICSI are healthy. But some subtle concerns remain. For instance, sperm that naturally bind to the egg (through the zona pellucida) show different DNA methylation patterns than those picked manually in ICSI—raising questions about long-term effects and even conditions like autism (Wang et al., 2021).As educators and professionals, we must emphasize informed consent and thorough male evaluation, not just fast-tracking to ICSI.

What Fertility Clinics Are Rethinking?

Some progressive clinics are:

• Limiting ICSI to genuine male infertility or specific scenarios.
  
• Offering split insemination techniques (half IVF, half ICSI) to reduce failure risk.
  
• Reducing patient costs by reserving ICSI for when it’s clinically justified.
  

Evidence shows that clinics with strict ICSI guidelines have maintained success rates while keeping ICSI use under 20% 

Learning for the Next Generation of Fertility Experts

At The Fertilis Academy, we encourage our learners to:

• Question routine practices.
  
• Look beyond convenience.
  
• Evaluate treatments through the lens of evidence, ethics, and outcomes.
  

ICSI is an incredible tool—but a tool, not a cure-all. As clinicians, embryologists, and fertility educators, we must champion precision and personalization in care.

• Science is powerful—but must be precise.
  
• Technology is a tool—not a substitute for clinical judgment.
  

We believe every fertility professional should know not just how to do ICSI, but when not to do it. Personalized treatment, thorough diagnostics (especially for men), and open conversations with patients are non-negotiables in modern reproductive medicine.

 Reference:

This blog was inspired by the article by Dr. Robert John Norman, originally published in Fertility and Sterility. You can read the full paper here.

Norman, R.J. (2022). Intracytoplasmic sperm injection 30 years on: too much of a good thing? Fertility and Sterility, 117(2), 268–269.  Read the full article at Click Here