IVF with or without ICSI: Which Fertility Treatment Is Right for You?

For some couples who have trouble conceiving a baby, in vitro fertilization in vitro fertilization (IVF) is one possible route to a successful pregnancy. One IVF technique — intracytoplasmic sperm injection (ICSI) — is a good option for treating male infertility.

Here, we look at IVF with and without ICSI to determine who can benefit from each type of treatment.

What Are Fertility Treatments?

Fertility treatments are medical procedures that help people become pregnant. Infertility means you’ve been trying to get pregnant for at least 12 months with no success.

Doctors will recommend trying the least complex, least costly fertility treatments first. The method your doctor suggests may depend on the cause of infertility, your age, and any other health issues you have.

Fertility treatments include:

  • Medicines that stimulate ovulation, or the release of an egg from the ovary.
  • Surgical procedures to repair fallopian tubes, treat endometriosis, or correct blockages that prevent sperm from leaving the body.
  • Artificial insemination, which involves inserting sperm into the uterus through a thin plastic tube.
  • Assisted reproductive technology (ART). These are fertility treatments that combine the egg and sperm in a laboratory and then place them in a woman’s body.

ICSI and IVF are both types of ART.

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What Is IVF?

IVF is the most common type of ART, comprising about 99% of ART procedures, according to the U.S. Department of Health and Human Services (HHS). In IVF, doctors remove mature female eggs from the ovaries with a needle. They then put them together with sperm in a lab.

The first baby born through IVF was in England in 1978. In the early days of ART, people used to refer to infants born through IVF as “test-tube babies.”

The procedure is now a common treatment for many couples facing infertility or for same-sex couples who want to have children. IVF can allow couples to try to avoid having a child with serious diseases that run in their family. It can also allow people to use fertility preservation services to save eggs or sperm to have children later in life. People undergoing fertility-reducing treatments for cancer, sickle cell anemia, or lupus may also opt for fertility preservation.

People use IVF to conceive more than 2% of all babies born in the U.S., according to the HHS.

What happens during IVF?

IVF is a complex procedure. For most people, one cycle of IVF takes four to six weeks to complete. Here are the basic steps of the process:

  • Ovarian stimulation. Doctors give you medicine that you take as injections in the lower belly. This medication helps your eggs mature.
  • Egg retrieval. Doctors remove mature eggs from your ovaries with a needle. They use ultrasound to produce a picture of your ovaries and help guide the needle.
  • Fertilization. Doctors place thousands of sperm next to the egg in a culture dish in hopes that one will enter the egg. If fertilization is successful, the embryo develops for a few days in the lab.
  • Embryo transfer. Doctors insert a long thin tube into the vagina and place one or more embryos in the uterus.
  • Pregnancy. Pregnancy is when any of the embryos attach to the lining of your uterus. After the embryo transfer, you need to wait about two weeks to take a pregnancy test to see if the IVF worked.

Who’s a good candidate for IVF?

You might be a good candidate for IVF if you:

  • Are older and unlikely to have success with less invasive treatments.
  • Have blocked or damaged fallopian tubes.
  • Have fertility problems for no known reason.
  • Have low sperm counts or sperm with abnormal shapes or movements.
  • Have problems with ovulation.
  • Have tried other treatments that didn’t work.
  • Plan on using a surrogate to carry the pregnancy.

Risks of IVF

As with any medical procedure, IVF comes with some potential health risks. They include:

  • Bleeding.
  • Ectopic pregnancy.
  • High blood pressure.
  • Infection.
  • A low birthweight baby.
  • Multiple births.
  • Ovarian hyperstimulation syndrome (OHSS).
  • Placental complications.
  • Preterm birth.
  • A slightly higher risk of birth defects than with natural conception.
  • The need for a cesarean section (C-section) during delivery.

What Is ICSI?

ICSI is a procedure some undergo as part of IVF. Doctors typically recommend ICSI to help with male fertility problems.

The difference between ICSI and traditional IVF is the technique doctors use to fertilize the eggs. Instead of mixing the egg with thousands of sperm in a culture dish, doctors inject a single sperm into the egg.

What happens during ICSI?

The process for ICSI is the same as it is for traditional IVF, with one exception. In ICSI, doctors use a tiny needle to inject one sperm into the middle of the egg. As with conventional IVF, after the doctor fertilizes the egg, it grows in the lab for days before they transfer it to the woman’s uterus.

Who’s a good candidate for ICSI?

Your doctor may recommend ICSI if:

  • If you have a blockage in the male reproductive tract that prevents sperm from getting out.
  • If you’ve had a vasectomy but decide you want children.
  • You have a very low sperm count.
  • You have abnormally shaped sperm.
  • Your sperm don’t move the way they should.
  • You’re using previously frozen eggs for IVF.
  • You’ve tried traditional IVF without success.
  • You’ve had IVF cycles without getting a lot of eggs.

Risks of ICSI

The health risks of ICSI are the same as they are for traditional IVF.

ICSI Vs. IVF: Which Fertility Treatment Is Right for Me?

The success rates for traditional IVF and ICSI are very similar. According to the Society for Assisted Reproductive Technology, about 50% of these procedures in women 35 and younger result in a live birth.

For women 42 and older, however, the number drops significantly. Fewer than 4% of IVF procedures result in a live birth. You should talk to your doctor about your individual odds of success with traditional IVF or ICSI.

Your doctor can also talk to you about different types of fertility treatments and which is the best for your situation. There are many factors to consider, including age, overall health, and the conditions causing infertility.

Finally, you need to weigh the financial cost against the likelihood of success.

One of the main negatives of IVF is the cost. According to the U.S. Department of Health and Human Services, a single cycle of IVF can range from $15,000 to $30,000, and ICSI can add more to that total. Insurance usually doesn’t cover fertility treatments.

Centers for Disease Control and Prevention. ART and Intracytoplasmic Sperm Injection (ICSI) in the United States. Link 

American Society for Reproductive Medicine. What Is Intracytoplasmic Sperm Injection (ICSI)? Link 

Human Fertilisation & Embryology Authority. In vitro fertilisation (IVF). Link 

March of Dimes. Thinking about fertility treatment. Link

Society for Assisted Reproductive Technology. FAQs. Link

U.S. Department of Health and Human Services. Fact Sheet: In Vitro Fertilization (IVF) Use Across the United States. Link

Society for Assisted Reproductive Technology. Final National Summary Report 2021. Link

About UPMC Magee-Womens

Built upon our flagship, UPMC Magee-Womens Hospital in Pittsburgh, and its century-plus history of providing high-quality medical care for people at all stages of life, UPMC Magee-Womens is nationally renowned for its outstanding care for women and their families.

Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.