ICSI is an assisted reproductive technology in which only one sperm, the strongest and most viable sperm, is extracted from the man’s sperm and placed in the egg.

This is a necessary measure in case you notice some problems with the semen quality or quantity, sluggishness or a high number of spermatozoa with defects.

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Generally, ICSI draws spermatozoa from the seminal fluid but sometimes the sperm quality is so poor that it has to be extracted surgically, and not from the ejaculate but from the testicles.

Sperm is surgically extracted from the seminal tract, testicle or testicular appendage if the sperm in the ejaculate is of insufficient quality. It is a minimally invasive procedure (minimal invasion of the body) and is done under a simple local anaesthetic.


Surgical sperm extraction is not always used. It is mostly used for 3 groups of men:

Men whose ejaculate is completely devoid of sperm.

This is due to the specific structure of the male reproductive organs. This is the case when sperm is produced but does not reach the ejaculate from the testicles due to an obstacle. Such an obstacle can be the absence of the vas deferens (congenital or acquired), vasectomy (a procedure to pull the seminal tubules as a radical method of contraception), suffered inflammatory diseases and other reasons.

Men with complete absence of sperm in the ejaculate.

This is because the testicles do not produce sperm. However, about half of these men have areas in their testicles that are still capable of producing sperm, but these sperm do not make it into the sperm. Unfortunately, there is no way to return these men to full reproductive health, so sperm extraction has to be done surgically. A biopsy (tissue sampling) has to be performed and this gives 50% of such men a chance to still have genetically related children.

For men who do not ejaculate.


There are two surgical methods to extract sperm:

PESA, or sperm extraction through the skin.

This is the best of the 2 ways to obtain sperm and if it is possible, doctors prefer to use it. A thin needle is inserted into the testicular appendages and sperm is extracted from there. The sperm is then checked under a microscope to see if there are spermatozoa in the sample taken.


This procedure involves inserting a needle into the testicle and examining the tissue under a microscope. If no spermatozoa are found in the tissue, a biopsy is taken: a small sample of tissue is taken directly from the testicle and individual spermatozoa are extracted from it.

Unfortunately, sperm obtained in this way is not suitable for natural conception due to its immaturity, and doctors use the ICSI method.

After the operation the affected area is covered with sutures, which automatically dissolve after about 10 hours. You may experience pain and discomfort in the scrotum for 1-2 days. To get rid of these, the doctor will recommend an analgesic.

Excess sperm and tissue are usually frozen in order to avoid repeating the procedure if another sample is needed for subsequent ICSI procedures.

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