When is intracytoplasmic sperm injection indicated over conventional IVF?

• A. In cases of severe male factor infertility, prior fertilization failure, or high risk of total fertilization failure
• B. For all IVF cycles regardless of semen parameters
• C. Only when ovarian stimulation fails
• D. Only in donor egg cycles

Answer: (A)

Intracytoplasmic sperm injection is chosen when fertilization is at substantial risk due to sperm quality or past fertilization problems. By injecting a single viable sperm directly into the oocyte, ICSI bypasses many sperm-related barriers to fertilization, making it the preferred approach in severe male factor infertility, in cases of prior fertilization failure with conventional IVF, or when there is a high risk of total fertilization failure. It isn’t needed for all IVF cycles—only when semen parameters or previous cycle history make fertilization uncertain; it’s not restricted to donor egg cycles or tied to ovarian stimulation failure.