Medically reviewed by: Dr. Parija Juneja, Obstetrician & Gynecologist, IVF Specialist
Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Always consult a qualified fertility specialist before making any decisions about treatment.
Do you know what couples find hardest about a failed IVF cycle? It is not the failure itself, because failure is far more common than most people are told before they begin. It is the question which the cycle leaves behind and never answers, which is simply why it did not work. The embryo quality was adequate, the transfer went smoothly, and there is nothing in the notes which explains it to you. However, the investigation has to go somewhere, and for some couples it goes right back to the first step of the whole process, which is how the sperm and the egg came together in the first place. So what this means is that ICSI becomes relevant to you at that point, not as a last resort but as a more precise version of what your cycle had already been doing.
Why Do Good Embryos Still Fail?
It is important for you to know that embryo grading measures morphology and not function, and the gap which sits between those two is exactly where a cycle that looked good on paper comes apart. Two explanations account for most of the failures at this stage. One of them is a uterine environment which will not support implantation, and the other is a fertilisation quality which standard IVF insemination is not able to overcome. It is the second of those which turns the choice between IVF and ICSI into a clinical question rather than a matter of preference.
You may not realize just how much normal IVF demands from the sperm. Your eggs and the prepared sperm are then put in a dish and the sperm is allowed to fertilise the egg, so it must have an adequate number, be mobile, and have the ability to get through the outer layer of the egg. However, if any of those is compromised even a little, even in a manner which a normal semen analysis would not detect, what follows is fertilisation that is never going to happen, or incomplete fertilisation, or embryos that have problems that only become apparent later.
What Separates IVF From ICSI?
The two procedures are similar in all ways except at the time of fertilisation itself, when, with conventional IVF, the embryologist places thousands of sperm with each egg, and one of them is free to fertilise the egg, while with ICSI, the embryologist will choose one sperm and inject it into the egg.
This is followed by practical differences. In the former, selection is left to nature; in the latter, it is done by the embryologist. Conventional IVF is used for normal sperm parameters, while ICSI is used if there is a low sperm count, low motility, poor morphology or when the previous cycle has failed. However, in the cases in which it is truly indicated, the fertilisation rate obtained by ICSI is in general the higher of the two.
What’s important to keep in mind is what ICSI does not do for you. Does not make your embryo better. It eliminates the need for the sperm to come in contact with and penetrate the egg without assistance; if the sperm is the one under suspicion, the elimination of the variable is important.
When Is ICSI Recommended?
ICSI is not a universal upgrade to IVF, whatever it may look like from the outside. It is indicated where there is a specific clinical reason for it. The ESHRE guidelines on male infertility and ART identify the primary indications as these:
- Severe oligozoospermia, where the sperm count is very low
- Asthenozoospermia, where the sperm motility is poor
- Teratozoospermia, where a high percentage of the sperm are abnormally shaped
- Surgically retrieved sperm, where TESA, TESE or micro-TESE has been used
- A prior IVF cycle with total or near-total fertilisation failure, where the previous attempt has already shown the problem
- A small number of eggs available, where the risk of fertilisation failure simply cannot be accepted
Those last two are where ICSI treatment in Delhi becomes most relevant to you after a failed cycle, and particularly so where the fertilisation rate came in lower than expected or where some of the eggs did not fertilise at all.
Does ICSI Fix a Failed Cycle?
Here we would rather be honest with you than encouraging. ICSI addresses fertilisation. It does not address every cause of IVF failure. Where the failed cycle pointed towards an implantation problem rather than a fertilisation problem, switching to ICSI for the next cycle may not change your outcome at all.
A Cochrane review comparing ICSI against conventional IVF found no significant difference in live birth rates for couples with unexplained infertility and normal sperm parameters. So what this means is that ICSI is not universally superior, and that using it without an indication buys you procedural complexity without a demonstrated benefit. It is recommended that the investigation after a failed cycle establishes which factor was most likely responsible before anybody recommends a change of protocol.
What Else Should Be Investigated?
A failed cycle with good embryos warrants full reassessment. The uterine cavity is examined by hysteroscopy. Endometrial receptivity is assessed. Immunological factors are considered. Sperm DNA fragmentation is tested, and a standard semen analysis does not capture it. That last one matters after unexplained fertilisation problems or poor embryo development, because it is invisible to morphology grading and still affects how an embryo develops. It is recommended that your next protocol reflects whatever those findings show, rather than repeating what was done before.
Where Should You Go Next?
At Vardhini IVF & Women Care Hospital a failed-cycle review forms part of the care pathway, so it is not something you have to ask for yourself. A fertility specialist in Delhi reviews every case individually in order to determine whether ICSI or some other change of protocol is indicated for you. Go for the answer before you repeat the cycle, and book a consultation to begin that review.