3rd November 2022
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What is PICSI?
According to Dr. Abha Bhat, Consultant Gynaecologist, PICSI, or Physiological ICSI, is a modified form of the ICSI procedure that may benefit a subset of patients who require ICSI.
Men with poorer sperm samples often have a greater degree of immature sperm. Immature sperm can still show normal motility (movement) and morphology (form, shape, or structure), however, they may have higher levels of damaged DNA, which, if selected for insemination can result in poor embryo quality and pregnancy loss. PICSI is a special method that helps us to select mature sperm for injection.
At Herts & Essex Fertility Centre, we include an HBA (Hyaluron Binding Assay) test in all of our semen assessments. It is this test that will look at the percentage of mature sperm within the sample to determine if PICSI would be the best treatment to benefit the patient.
The Clinician will guide the patient as to whether PICSI would be the most appropriate treatment. There are no additional risks in using sperm selected by this method.
When may PICSI be required?
ICSI and PICSI are treatments that may be indicated for Male Factor infertility in the following cases:
- When the HBA score at semen assessment is less than 65%, indicating a reduced level of mature sperm within the sample.
There is some evidence from scientific literature, which indicates that couples with recurrent pregnancy loss or those with slow or poorly developing embryos may also benefit from PICSI. However, the number of studies using PICSI is currently limited and there is no clear indication that this would be of benefit, with varying results from different studies to date. The Fertility Specialist will discuss this thoroughly with the patient if the sample demonstrates an increased percentage of immature sperm. The patient will then be able to make an informed decision about whether they would like to include this additional treatment in their treatment plan with us.
PICSI can also be performed at a patient’s request.
During PICSI, the embryologist is able to distinguish between mature sperm that have completed their full development and immature sperm that are more likely to have damaged DNA or the wrong number of chromosomes. The embryologist cannot do this by just looking down the microscope, as in the routine ICSI procedure, as mature and immature sperm will have the same appearance.
In the PICSI procedure, the Embryologist will only use mature sperm to inject directly into mature eggs. Following the PICSI, the injected eggs are incubated overnight and assessed the following morning for evidence of fertilisation. The average fertilisation rate following PICSI is similar to ICSI and IVF, with 60-70% of injected eggs fertilising normally following PICSI.
For further information on PICSI, please visit the HFEA website: