What are common indications for using ICSI?

• A. Male-factor infertility (severe oligo/azoospermia), previous fertilization failure, severe sperm defects, or use of surgically retrieved sperm.
• B. Female-factor infertility as sole indication.
• C. Only donor eggs require ICSI.
• D. ICSI is used only when there is no need for ovarian stimulation.

Answer: (B)

ICSI is chosen when fertilization is likely to be compromised by the sperm rather than the egg. The typical indications are severe male-factor infertility—such as very low sperm count (oligozoospermia) or no sperm in the ejaculate (azoospermia)—as well as situations where sperm defects prevent normal fertilization, including severe abnormalities in sperm morphology or motility, or when sperm must be retrieved surgically from the testes or epididymis. It’s also used after a history of fertilization failure with conventional IVF, where insemination of the egg by mixed sperm did not lead to fertilization.

Female-factor infertility alone is not the primary indication for ICSI, though ICSI may be used in certain complex cases or when there’s a coexisting male-factor issue or prior fertilization failure. Donor eggs are not required for ICSI; either partner’s eggs can be used. Ovarian stimulation is typically part of the IVF/ICSI cycle to retrieve multiple eggs, so the idea that ICSI is used only when no stimulation is needed is not correct.