Introduction

Male infertility is a common cause of conception problems in couples. One of the most frequent reasons is a low sperm count, medically known as oligospermia. When natural conception becomes difficult, assisted reproductive technologies (ART) like Intracytoplasmic Sperm Injection (ICSI) offer hope. 

Let’s explore the chances of success with ICSI and how it works in cases of male infertility.

Understanding Low Sperm Count

A man is said to have a low sperm count if his semen contains fewer sperm than normal. According to WHO guidelines, a normal sperm count is at least 15 million sperm per milliliter of semen. Anything below this is considered low and can impact the ability to conceive naturally.

Common causes include:

  • Hormonal imbalances

  • Genetic disorders

  • Lifestyle factors (smoking, alcohol, stress)

  • Testicular trauma or infections

  • Varicocele (enlarged veins in the scrotum)

While some men with low sperm count can still father a child naturally, many need assistance through fertility treatments like ICSI.

What Is ICSI?

ICSI (Intracytoplasmic Sperm Injection) is a specialized form of in vitro fertilization (IVF). In this ICSI Procedure, a single healthy sperm is directly injected into an egg using a microscopic needle. This bypasses many natural barriers that sperm with low count or poor motility cannot overcome.

ICSI is especially useful when:

  • The sperm count is extremely low

  • Sperm has poor motility or abnormal shape

  • Previous IVF cycles have failed

  • Sperm must be retrieved surgically (e.g., in azoospermia)

ICSI Success Rates with Low Sperm Count

ICSI significantly improves fertilization chances in men with low sperm count. But the overall success still depends on multiple factors.

Key Success Factors:

  1. Sperm Quality
    Even if the count is low, success depends on the ability to find at least a few viable sperm with normal morphology.

  2. Egg Quality
    Healthy eggs from the female partner increase the chance of fertilization and embryo development.

  3. Embryo Quality
    High-quality embryos have a better chance of implantation and successful pregnancy.

  4. Female Partner’s Age
    Women under 35 generally have higher ICSI success rates compared to those over 35.

  5. Fertility Clinic Expertise
    A well-equipped lab and an experienced embryologist can increase ICSI outcomes.

Average Success Rates

  • Fertilization Rate: Around 70-80% of mature eggs injected with sperm result in fertilization.

  • Clinical Pregnancy Rate per Cycle: Approximately 40-45% for women under 35.

  • Live Birth Rate: Around 30-35%, depending on age and clinic standards.

It’s important to note that a low sperm count alone does not drastically reduce the success of ICSI. As long as viable sperm can be retrieved, ICSI offers a high probability of successful fertilization.

Sperm Retrieval Methods for ICSI

For men with extremely low or no sperm in the ejaculate, advanced techniques are available:

  • TESA (Testicular Sperm Aspiration)
    A fine needle is used to extract sperm directly from the testicle.

  • PESA (Percutaneous Epididymal Sperm Aspiration)
    Sperm is retrieved from the epididymis.

  • Micro-TESE (Microsurgical Testicular Sperm Extraction)
    A surgical microscope helps identify and extract sperm-producing tubules from the testis.

Even in severe cases of male infertility, ICSI combined with these retrieval techniques can offer successful outcomes.

Is ICSI the Best Option for Low Sperm Count?

Yes, ICSI is currently the most effective treatment for severe male factor infertility. It bypasses many natural hurdles and requires only one healthy sperm to fertilize an egg. Compared to conventional IVF, ICSI offers much better outcomes in men with low sperm count.

It is also the preferred method when:

  • Sperm motility is extremely poor

  • Morphological defects are high

  • Previous IVF attempts have failed due to fertilization issues

Tips to Improve ICSI Success for Low Sperm Count

While the procedure is highly technical, couples can take steps to improve their chances:

  • Lifestyle Changes: Avoid smoking, alcohol, and processed foods. Exercise regularly and manage stress.

  • Nutrition: Take supplements like zinc, folic acid, vitamin E, and CoQ10.

  • Avoid Heat Exposure: Limit hot tubs, saunas, and tight clothing.

  • Medical Treatments: Treat infections or hormonal imbalances if present.

  • Timing: Start treatment early, especially if the female partner is older.

Final Thoughts

ICSI has revolutionized the way couples with male infertility treatment in Pakistan, particularly low sperm count, achieve parenthood. With fertilization rates as high as 80% and promising pregnancy outcomes, it offers real hope to those struggling with male factor infertility.

However, every case is different. Success depends on both partners’ health, the quality of the eggs and sperm, and the skill of the fertility team. A consultation with a qualified fertility specialist can help determine if ICSI is the right choice.