Making ICSI Safer and More Effective: A Review of the Human Oocyte and ICSI Practice

Intracytoplasmic sperm injection (ICSI) has become an indispensable procedure of every assisted reproduction unit. This has created as much controversy as it has awe. As this is a multistep invasive technique, every part of the procedure has become subject to investigation. We contribute this review aspiring to offer the embryologist insight into all available approaches of securing an effective ICSI practice. Herein we present all the different approaches with respect to handling of the human oocyte, taking into consideration the important steps of the technique such as the oocyte positioning, timing of performing ICSI, the option of viewing the meiotic spindle and further individual action such as artificial oocyte activation, rescue ICSI and in vitro maturation. We enrich this by including our view based on our collective experience and current practice. Published studies have led to various options for performing ICSI, resulting in in vitro fertilization units around the world adopting different approaches. The steps that ICSI technique entails discussed from the oocyte perspective are still a long way from being organized into one secure and optimal protocol. Our stressing of the need to secure an efficient ICSI protocol could be the trigger for further well-designed larger scale studies with all the latest technological advantages. We aim to approach this subject in categories and assess them separately. However, ICSI is a multifaceted procedure involving several consecutive steps and when evaluating one we cannot exclude the end effect of the previous, or the overall effect of the different practitioners involved form beginning to end.