From a patient perspective, undergoing an ICSI treatment cycle is exactly the same as a conventional IVF cycle, and the same steps are involved.

Circumstances in which ICSI may be appropriate include:

• When the sperm count is very low
• When the sperm cannot move properly or are in other ways abnormal
• When sperm has been retrieved surgically from the epididymis (MESA/PESA) or the testes
• (TESE/TESA), from urine or following electro-ejaculation
• When there are high levels of antibodies in the semen
• When there has been a previous fertilisation failure using conventional IVF.

There are basically five simple steps to ICSI which include the following:

1.  The mature egg is held with a specialized pipette.
2.  A very delicate, sharp, and hollow needle is used to immobilize and pick up a single sperm.
3.  The needle is then carefully inserted through the shell of the egg and into the cytoplasm of the egg.
4.  The sperm is injected into the cytoplasm, and the needle is carefully removed.
5.  The eggs are checked the following day for evidence of normal fertilization.

• Donor sperm. For women who need to use donor sperm to get pregnant, IUI is most commonly used to achieve pregnancy. Frozen donor sperm specimens are obtained from certified labs and thawed before the IUI procedure.
• Unexplained infertility. IUI is often performed as a first treatment for unexplained infertility along with ovulation-inducing medications.
• Endometriosis-related infertility. For infertility related to endometriosis, using medications to obtain a good-quality egg along with performing IUI is often the first treatment approach.
• Mild male factor infertility (subfertility). Your partner’s semen analysis, one of the first steps in the medical assessment of infertility, may show below-average sperm concentration, weak movement (motility) of sperm, or abnormalities in sperm size and shape (morphology). IUI can overcome some of these problems because preparing sperm for the procedure helps separate highly motile, normal sperm from those of lower quality.
• Cervical factor infertility. Your cervix, at the lower end of the uterus, provides the opening between your vagina and uterus. Mucus produced by the cervix around the time of ovulation provides an ideal environment for sperm to travel from your vagina to the fallopian tubes. But, if your cervical mucus is too thick, it may impede the sperm’s journey. The cervix itself may also prevent sperm from reaching the egg. Scarring, such as that caused by a biopsy or other procedures, can cause the cervix to thicken. IUI bypasses your cervix, depositing sperm directly into your uterus and increasing the number of sperm available to meet the awaiting egg.
• Ovulatory factor infertility. IUI may also be performed for women who have infertility caused by problems with ovulation, including an absence of ovulation or a reduced number of eggs.
• Semen allergy. Rarely, a woman could have an allergy to proteins in her partner’s semen. Ejaculation into the vagina causes redness, burning and swelling where the semen contacts the skin. A condom can protect you from the symptoms, but it also prevents pregnancy. If your sensitivity is severe, IUI can be effective, since many of the proteins in semen are removed before the sperm is inserted.

Intrauterine insemination involves careful coordination before the actual procedure:

• Preparing the semen sample. Your partner provides a semen sample at the doctor’s office, or a vial of frozen donor sperm can be thawed and prepared. Because nonsperm elements in semen can cause reactions in the woman’s body that interfere with fertilization, the sample will be washed in a way that separates the highly active, normal sperm from lower quality sperm and other elements. The likelihood of achieving pregnancy increases by using a small, highly concentrated sample of healthy sperm.
• Monitoring for ovulation. Because the timing of IUI is crucial, monitoring for signs of impending ovulation is critical. To do this, you might use an at-home urine ovulation predictor kit that detects when your body produces a surge or release of luteinizing hormone (LH). Or, an imaging method that lets your doctor visualize your ovaries and egg growth (transvaginal ultrasound) can be done. You also may be given an injection of human chorionic gonadotropin (HCG) or medications to make you ovulate one or more eggs at the right time.
• Determining optimal timing. Most IUIs are done a day or two after detecting ovulation. Your doctor or other care provider will have a plan spelled out for the timing of your procedure and what to expect.

What you can expect

The visit for intrauterine insemination takes about 15 to 20 minutes and is usually done in a doctor’s office or clinic. The IUI procedure itself takes just a minute or two and requires no medications or pain relievers. Your doctor or a specially trained nurse performs the procedure.

During the procedure

While lying on an exam table, you’ll put your legs into stirrups and a speculum will be inserted into your vagina — similar to what you experience during a Pap test. During the procedure, the doctor or nurse:

After the procedure

• Attaches a vial containing a sample of healthy sperm to the end of a long, thin, flexible tube (catheter)
• Inserts the catheter into your vagina, through your cervical opening and into your uterus
• Pushes the sperm sample through the tube into your uterus
• Removes the catheter, followed by the speculum

After insemination, you’ll be asked to lie on your back for a brief period. Once the procedure is over, you can get dressed and go about your normal daily activities. You may experience some light spotting for a day or two after the procedure.

Gamete or embryo donation makes it possible to have a child when one or both partners are not able to provide their own sperm, eggs, or embryos. Egg or sperm donation allows one of the intended parents to keep the genetic link to the child. With egg donation, the intended parent is able to experience a biological connection to the child through the pregnancy. With embryo donation, there is no genetic link. However, the intended parents are able to experience pregnancy and birth.

Some people use donated gametes or embryos because of medical issues, such as no or poor quality eggs or sperm. Some use donation so they do not risk passing down genetic disorders to their children. Donation can also be used for social reasons such as same-sex couples or for single men or women.

• Consult with specialists in reproductive medicine who are qualified and experienced.
• Use legal counsel that is well-versed in reproductive law in locations where both the donor and recipients reside.
• Work with a mental health professional who is experienced and familiar with the issues of third-party family-building. 
• Consider if, when, what, and how to tell the child and others.
• Understand that:  — Laws regarding reproductive rights are constantly changing. — Files regarding donation identities may be opened at any time (if they are challenged in court or if current laws change). — Confidentiality cannot be guaranteed. — Secrets are difficult to keep, and information can be unintentionally shared or discovered with science and technology that are advanced and more widely accessible.  — Making peace with your personal feelings about donation must be done before sharing this information.

Key considerations:

• Consult with specialists in reproductive medicine who are qualified and experienced.
• Use legal counsel that is well-versed in reproductive law in locations where both the donor and recipients reside.
• Work with a mental health professional who is experienced and familiar with the issues of third-party family-building. 
• Consider if, when, what, and how to tell the child and others.
• Understand that:  — Laws regarding reproductive rights are constantly changing. — Files regarding donation identities may be opened at any time (if they are challenged in court or if current laws change). — Confidentiality cannot be guaranteed. — Secrets are difficult to keep, and information can be unintentionally shared or discovered with science and technology that are advanced and more widely accessible.  — Making peace with your personal feelings about donation must be done before sharing this information.