Can ICSI help with very low sperm count?
Being told you have a very low sperm count can be hard to hear. For many patients, it raises immediate questions about whether they'll be able to conceive using their own sperm.
The good news is that treatments such as ICSI (intracytoplasmic sperm injection) have been developed specifically to help when sperm numbers are very low.
In this blog post, our medical director, Dr Amanda Jefferys, explains how ICSI works, when it may be recommended and what treatment involves.
ICSI and low sperm count at a glance
- Can ICSI help with a very low sperm count? Yes. One suitable sperm is needed for each mature egg treated with ICSI.
- What tests will I need? Semen analysis looks at sperm numbers, movement and shape, with further investigations available when needed.
- What if there are no sperm in my semen? Surgical sperm retrieval can sometimes collect sperm directly for use with ICSI.
- Does sperm quality still matter with ICSI? Yes. Sperm health remains important because sperm contributes half of the genetic material needed to create an embryo.
- Does ICSI improve the chance of pregnancy? ICSI can improve fertilisation when sperm-related problems make this more difficult.
What does a very low sperm count mean?
A low sperm count simply means there are fewer sperm in the semen than we would usually expect to see.
As a guide, the World Health Organization uses 16 million sperm per millilitre as the lower reference point, while a count of around 5 million per millilitre or less is often considered very low.
These figures are useful, although sperm count is only one part of your fertility assessment.
A semen analysis also looks at:
- Total sperm count: the overall number of sperm in the sample.
- Motility: how well the sperm are moving.
- Morphology: the proportion of sperm with a normal shape.
Looking at the results together helps your fertility team understand how sperm health could be affecting your chances of conception and which treatment options are most appropriate.
An abnormal result might also be checked with another semen analysis because sperm production can change over time and temporary factors such as illness can affect a sample.
How does ICSI help when sperm count is very low?
During conventional IVF, prepared sperm are placed with the eggs in the laboratory. Fertilisation happens when a sperm successfully reaches and enters an egg.
ICSI gives the embryologist more control over this stage. A suitable sperm is selected under magnification and injected directly into a mature egg using a very fine needle.
Because only one sperm is needed for each mature egg, ICSI can be used even when very few suitable sperm are available.
At BCRM, ICSI is used for male fertility problems such as a low sperm count, reduced sperm movement or a low percentage of normal shaped sperm. It can also be used with surgically retrieved sperm and following previous IVF where fertilisation has been lower than expected.
Once fertilisation has taken place, the embryos are monitored in the laboratory in the same way as embryos created through conventional IVF.
Is there a sperm count that's too low for ICSI?
There is no single sperm count that determines whether ICSI can be carried out.
The embryology team needs enough suitable sperm for the mature eggs available, so your sperm concentration is considered alongside the rest of your semen analysis and your wider fertility history.
Even a sample containing very few sperm can sometimes provide enough for treatment.
If no sperm are found in the semen, further investigation can help establish why and whether sperm might still be available for use with ICSI.
What happens if no sperm are found in the semen?
When no sperm are present in the ejaculate, this is known as azoospermia.
There are different reasons this can happen. Sperm production can be severely reduced, or a blockage can prevent sperm from reaching the semen.
Further assessment can include hormone or genetic testing where there is evidence of a significant problem with sperm production. These investigations can help the clinical team understand the possible cause and plan your treatment.
In some cases, sperm are still being produced within the testicles and can be collected using surgical sperm recovery.
Techniques available include:
- PESA: sperm are collected from the epididymis using a fine needle.
- TESE: small samples of tissue are taken from the testicle so the laboratory can look for sperm.
Sperm collected successfully can then be frozen and used with ICSI.
What else do we look at before ICSI?
A very low sperm count is only one part of the picture. Before treatment, your fertility team will also look at your wider sperm health and anything in your medical history that could be affecting fertility.
Depending on your results, further assessment can include:
- A repeat semen analysis to confirm the result, as sperm production can vary over time.
- Hormone tests to check the hormones involved in sperm production.
- Genetic testing where sperm production is particularly low.
- Sperm DNA fragmentation testing to look for damage to the DNA carried by sperm.
Your consultant will also review previous illnesses, surgery, medicines and other factors that could be relevant to your fertility.
Together, this information helps build a clearer picture of your sperm health before treatment begins. That’s important with ICSI because, while the technique helps a sperm fertilise an egg, the health of the sperm itself still plays an important role in creating an embryo.
Does ICSI improve the chance of pregnancy?
ICSI can improve the chance of fertilisation when sperm-related problems are making this stage more difficult.
For patients with severe male factor infertility, injecting a sperm directly into an egg gives the sperm the help it needs to fertilise the egg.
Once embryos have been created, your chance of pregnancy also depends on factors such as egg quality, female age, embryo development and your wider fertility history.
Pregnancy rates following ICSI are generally similar to conventional IVF once fertilisation and embryo development have taken place.
Is ICSI safe?
ICSI is generally considered a safe and well-established fertility treatment, and it has been used for more than 30 years.
However, there are some risks associated with the procedure. For example, because ICSI involves injecting a single sperm directly into a mature egg, a small number of eggs can be damaged during treatment.
Research has also found a small increase in certain genetic or developmental problems in children conceived following ICSI. Although some of this risk may be linked to the underlying male fertility condition rather than the ICSI procedure itself.
When should you see a male fertility specialist?
If a semen analysis has shown a very low sperm count, specialist assessment can help you understand what the result means and how it could affect your treatment.
You may also benefit from specialist advice if sperm movement or shape is significantly affected, previous treatment has resulted in poor fertilisation, or no sperm have been found in the ejaculate.
BCRM brings together male fertility assessment, specialist andrology, embryology, ICSI and surgical sperm retrieval within one fertility service, allowing your results and treatment options to be considered together.
If you have concerns about your sperm health or have already been told that your sperm count is very low, book a consultation with BCRM to discuss further assessment and whether ICSI could be suitable for you.