Low sperm count, but the wife's tests are normal: how does IVF with ICSI help?
When the husband's sperm count is low but the wife's tests are normal, IVF with ICSI lets the embryologist place one selected sperm directly into each mature egg, so fertilisation no longer depends on large numbers of sperm. The wife goes through the usual IVF steps, and the husband gives his sample on the egg-collection day.
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This is one of the most common situations in a fertility clinic: the wife's tests are all normal, but the husband's semen report shows a low count. In this video, Dr Mayur Pai explains how such a couple is assessed and treated, and why IVF with ICSI is so often the answer. For the wider picture, see male infertility explained.
Why a low count makes conception difficult
In natural conception, very large numbers of sperm set out, and only a few reach the egg. When the count is low, or the sperm do not move well, too few complete the journey. IUI helps by placing prepared sperm inside the womb, but it still needs a fair number of active sperm after preparation. Standard IVF needs many active sperm around each egg in the dish. When there are not enough for either, ICSI solves the problem directly.
If you are still deciding between the two routes, read low sperm count: IUI or IVF?
What ICSI is
ICSI stands for intracytoplasmic sperm injection. It is done in the IVF laboratory on the day of egg collection:
- The embryologist gently removes the cells around each egg and checks which eggs are mature. Only mature eggs can be injected.
- Under a high-power microscope, a healthy-looking, moving sperm is chosen and picked up in a very fine glass needle.
- The sperm is placed directly inside the egg.
- The next day, the eggs are checked to see which have fertilised, and the embryos are then grown for a few more days.
Because ICSI needs only one good sperm for each egg, it helps even when the count is very low.
What the husband goes through
Before treatment, the semen analysis is repeated, because counts vary from one test to another. Hormone tests and an examination look for a treatable cause, such as a varicocele. When the count is very low, a genetic blood test may be suggested, since some causes run in families. Healthy changes, such as stopping smoking, cutting down alcohol, avoiding heat and reaching a healthy weight, are worth starting early, because sperm take two to three months to form.
On the day of egg collection, he gives a fresh sample after the advised gap. If producing a sample on the day may be difficult, one can often be frozen in advance as a backup. When sperm are extremely few, or absent from the semen, they may be retrieved directly from the testis; see azoospermia: causes and treatment.
What the wife goes through
Even though her tests are normal, the treatment happens in her body. She has hormone injections for around ten to twelve days to help several eggs grow, with scans and blood tests to follow them. When the eggs are ready, a trigger injection prepares them, and the egg collection is done under light anaesthesia as a day procedure.
Because healthy ovaries can respond strongly, the medicines are set carefully and the response is watched closely to avoid over-stimulation. The embryo is usually transferred at the blastocyst stage, around the fifth day, and good extra embryos are frozen. The pregnancy test follows about two weeks later. The full sequence is explained in how IVF works, step by step.
The egg-collection day, for the couple
It is a long day, but not a hard one. The wife has her egg collection and rests afterwards. The husband gives his sample, which the laboratory prepares. A few hours later, the embryologist performs ICSI on the mature eggs. You go home the same day, and the next day you are told how many eggs have fertilised.
Is ICSI safe?
ICSI has been used around the world for many years and is a routine part of IVF laboratories today. The injection is done with great care, though an occasional egg may not survive it. Because some causes of a very low count can be inherited, a genetic test for the husband is sometimes advised before treatment. The doctor discusses this with you, so that you decide with full information.
What ICSI cannot do
ICSI solves the problem of sperm reaching and entering the egg. It cannot improve egg quality, and not every injected egg fertilises or grows into a good embryo. That is why the doctor explains the results at each step, rather than promising an outcome at the start.
A shorter explanation
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In this second video, Dr Mayur Pai explains IVF with ICSI for a low sperm count more briefly, which may help as a quick recap before your consultation.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so the egg collection, the sperm preparation and the ICSI all happen under one roof, on the same day. Free patient transport is available from across Goa.
Getting started
Send both partners' reports to us on WhatsApp at +91 95185 02773, with any questions you have. Consultations are by appointment, so please call our reception on +91 95459 20817 to book. Please come together as a couple. Our treatment packages are transparent and fixed, so just ask us about the cost of IVF with ICSI. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Your questions
What is the difference between IVF and ICSI?
In standard IVF, each egg is placed with many prepared sperm and fertilisation happens on its own. In ICSI, the embryologist injects one selected sperm into each mature egg. ICSI is a step within an IVF cycle, used when the sperm are too few or too weak to fertilise the eggs on their own.
Does the wife need injections if only the husband has a problem?
Yes. The eggs still have to be grown and collected, so she goes through the IVF injections, scans and egg collection. Because her ovaries are healthy, the medicines are adjusted carefully and her response is watched closely to keep her safe.
Can a low sperm count improve before IVF?
Sometimes, especially when a cause such as a varicocele or a hormone problem is treated, or when smoking, alcohol, heat and extra weight are addressed. Sperm take two to three months to form, so changes show on a later test. Planning for IVF and improving the sperm can run side by side.
What if the husband cannot give a sample on the day?
Tell us in advance. A sample can often be frozen beforehand as a backup. When sperm are extremely few or absent, they may be retrieved directly from the testis in a short procedure and used for ICSI.
How long does the whole treatment take?
From the start of the injections to the pregnancy test usually takes about a month when the embryo is transferred fresh, and longer when it is frozen and transferred in a later cycle. The tests and planning beforehand add a few weeks. The doctor gives you a clear calendar before you begin.
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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.