What is PICSI
(Physiological Intracytoplasmic Sperm Injection)?

PICSI, or Physiological Intracytoplasmic Sperm Injection, is an innovative technique utilized in assisted reproductive technology (ART) to enhance the success rates of in vitro fertilization (IVF). Unlike conventional IVF-ICSI methods where sperm selection relies on visual criteria, PICSI employs the physiological binding ability of sperm to hyaluronan, a substance naturally present in the female reproductive tract. The PICSI (Physiological Intracytoplasmic Sperm Injection) technique improves pregnancy rate and reduces the risk of miscarriages. The advantage of this method is the objective selection of spermatozoa based on their functional quality.

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picsi - physiological intracytoplasmic sperm injection

What is the principle of the method?

Hyaluronic acid is an important natural part of the eggshell. The head of the mature sperm contains a specific receptor that allows it to bind to hyaluronic acid. This is the process that occurs naturally in nature. Using the PICSI method, therefore, for fertilization, the embryologist chooses the spermatozoa that have a positive bond with the gel containing hyaluronic acid. The selected sperms are used for fertilization using the ICSI method.

Only a mature spermatozoon can have this interaction, which is biochemically competent for binding with hyaluronic acid. Scientific studies have confirmed that spermatozoa that bind to hyaluronic acid have better morphology, a lower percentage of chromosomal abnormalities and better DNA integrity.

Who is PICSI recommended for?

PICSI is recommended in the following cases:

  1. A high percentage of spermatozoa with fragmented DNA (High -DFI DNA fragmentation index)
  2. Woman’s age over 38.
  3. In previous failed fertilization cycles using ICSI.
  4. Development of low-quality embryos.
  5. Couple with a history of multiple abortions.

How is PICSI performed?

PICSI involves several steps:

  1. Preparation of Hyaluronan-Coated Dish: A dish is coated with a substance called hyaluronan, which is a component found in the cumulus cells surrounding the egg. This substance mimics the natural environment of the egg and helps in selecting mature and healthy sperm. In modern practice, ready to use pICSI dishes are used commonly.
  2. Semen Sample Collection: A semen sample is collected from the male partner. This sample undergoes processing to separate sperm from seminal fluid and other debris.
  3. Sperm Selection: The processed sperm sample is placed onto the hyaluronan-coated dish. Mature and healthy sperm have specific receptors that bind to hyaluronan. These sperm will adhere to the dish while immature or unhealthy sperm will not.
  4. Identification of Bound Sperm: Under a microscope, the bound sperm, which have attached to the hyaluronan, are identified. These sperm are considered to have better quality and are more likely to fertilize an egg successfully.
  5. Sperm Injection: The selected sperm are then individually picked up using a needle and injected directly into the egg cytoplasm using a technique called intracytoplasmic sperm injection (ICSI). This improves fertilization even in cases where sperm quality or quantity is low.

Advantages of using PICSI

PICSI offers several advantages:

  1. Improved embryo quality: By selecting sperm with optimal fertility potential, PICSI enhances the quality of embryos transferred during IVF procedures.
  2. Higher success rates: Studies have shown that PICSI results in higher pregnancy rates and lower miscarriage rates compared to traditional IVF methods.
  3. Reduced DNA fragmentation: PICSI minimizes the risk of DNA fragmentation by selecting sperm with intact DNA, contributing to improved IVF outcomes.

Disadvantages of using PICSI

While PICSI offers numerous benefits, it’s essential to consider potential limitations:

  1. Suitability: PICSI may not be suitable for all patients, particularly in cases of severe male factor infertility or extremely low sperm counts.
  2. Availability and cost: The availability and cost of PICSI may vary depending on the fertility clinic and geographic location.

When is PICSI indicated?

PICSI is specifically indicated in cases where sperm quality is low or compromised. It is particularly beneficial for couples with reduced sperm motility, morphology abnormalities, or high levels of DNA fragmentation. By selecting sperm with optimal functional competence, PICSI improves the chances of successful fertilization and embryo development.

How does PICSI influence IVF success rates?

PICSI significantly improves IVF success rates by enhancing sperm selection and embryo quality. Studies have demonstrated higher pregnancy rates and lower miscarriage rates in IVF cycles where PICSI was utilized. By selecting sperm with intact DNA and optimal fertility potential, PICSI contributes to improved outcomes in ART procedures.

Is PICSI better than ICSI?

PICSI and ICSI are both techniques used in ART to facilitate fertilization, but they differ in their approach to sperm selection. While ICSI involves the manual selection and injection of sperm into the egg, PICSI utilizes a physiological sperm selection process based on hyaluronan binding. The embryologist then selects the best sperm from available sperms which are bound to hyaluronan in a process similar to ICSi. Thus PICSI adds to the advantages offered by ICSI.


Numerous studies have demonstrated the efficacy of PICSI in improving IVF outcomes, including higher pregnancy rates and lower miscarriage rates. Clinical evidence supports the use of PICSI as a valuable tool in ART. However new evidence is always coming and may change the scenario. Currently no major professional body suggests routine use of PICSI in all patients.

PICSI is considered safe when performed by experienced fertility professionals in accredited fertility clinics. However, like any medical procedure, there are potential risks and complications associated with PICSI, which should be discussed with your healthcare provider.

IVF (In Vitro Fertilization) involves fertilizing eggs with sperm outside the body, while ICSI (Intracytoplasmic Sperm Injection) and PICSI are techniques used to facilitate fertilization by injecting sperm into the egg. PICSI specifically utilizes a physiological sperm selection process based on hyaluronan binding.

The cost of PICSI may vary depending on the fertility clinic, geographic location, and individual patient factors. It is recommended to inquire about the specific cost of PICSI and any associated fees during your initial consultation with a fertility specialist.

Yes, PICSI has been shown to reduce the risk of DNA fragmentation by selecting sperm with intact DNA and optimal functional competence. By minimizing DNA damage, PICSI contributes to improved embryo quality and higher success rates in IVF treatments.

The duration of the PICSI procedure typically depends on various factors such as clinic protocols and individual patient needs. Generally, the process involves sperm preparation, incubation, and selection, which may take a few hours to complete.

While PICSI is generally considered safe, serious complications are rare but can include infection or damage to the egg or embryo.

Yes, PICSI can be combined with other fertility treatments such as ovarian stimulation, preimplantation genetic testing (PGT), or embryo cryopreservation (freezing). Your fertility specialist will determine the most appropriate treatment plan based on your individual needs and circumstances.

Adopting a healthy lifestyle can positively impact the success of PICSI and overall fertility health. This may include maintaining a balanced diet, regular exercise, avoiding alcohol and tobacco, managing stress levels, and following any specific recommendations provided by your fertility specialist. Antioxidants as a part of supplements or diet may improve sperm quality marginally and help with the process.

After undergoing PICSI, routine care as any other IVF cycle is suggested.

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