Indications for Micro-Injection of Sperm in Assisted Reproduction: A Consensus Statement

Following the first report of use of intracytoplasmic sperm injection (ICSI) in 1992 there has been a consistent global increase in the use of ICSI to fertilise human oocytes in vitro, though since 2016 there has been a small reduction in its use in Australia and New Zealand This consensus statement, developed by the subspecialty group in reproductive endocrinology and infertility, reviews the evidence underpinning the use of ICSI. It is concluded that ICSI is an appropriate intervention when there is reduced semen quality or if there is a significant risk of failed fertilisation, though the exact seminal parameters which predict appropriate use of ICSI are uncertain. ICSI is an appropriate intervention when there has been failed or poor fertilisation rates in a previous IVF cycle. ICSI may be used to reduce the risk of recurrent molar pregnancy, but the evidence to support its use after oocyte cryopreservation, in vitro maturation of oocytes (IVM), prior to preimplantation genetic testing (PGT) and when treating HIV sero-discordant couples is lacking, and these are areas requiring further research. ICSI is not necessary in unexplained infertility when a low number of oocytes have been retrieved during the treatment cycle or when the female age is advanced if the semen parameters are normal.