ICSI is mainly applicable in male infertility including:
• Low sperm cells concentration in the ejaculate (Oligozoospermia)
• Poor sperm morphology (Teratozoospеrmia)
• Reduced sperm motility (Asthenozoospermia)
• Lack of sperm cells in the ejaculate (Azoospermia) – in this case, sperm cells are collected surgically from the epididymis or the testicles through TESE (Testicular Epididymal Sperm Extraction),  PESA (Percutaneous Epididymal Sperm Aspiration), MESA (Microsurgical Epididymal Sperm Aspiration), or TESA (Testicular Epididymal Sperm Aspiration)
• ICSI is also performed in some cases of female infertility, like the presence of antisperm antibodies

What is the difference between INF and ICSI?
The main difference between the two methods is in the laboratory. In IVF the oocyte is fertilized in a special petri dish with thousands of sperm cells from the partner. ICSI is similar, with the exception that only one sperm cell is chosen through a special micromanipulation system and this one sperm cell is injected in the cytoplasm of the oocyte.
After the follicular puncture, the follicles are carefully examined for oocytes and cumulus-oocyte complexes (COCs), and their number and quality (maturity, morphology) are reported. For a sperm injection the oocytes must be at a precise stage of maturity. This assessment is made through the COCs. Only the mature oocytes are injected with the help of micromanipulators. IVF, unlike ICSI, includes insemination of COCs.
In the day of the puncture, the partner gives material, which is precisely analyzed. During the analysis particular mediums are used to separate the viable sperm cells from those with poor quality, which are ineligible for ICSI. There is also a medium for immobilization of the sperm cells and collection of those one eligible for ICSI. If the partner is impeded to collect semen in the day of the procedure, the material could be pre-cryopreserved. The fertilization is detected the day after the sperm injection.
In the next few days, the embryos are cultivated through two different mediums. The first one is used between day 2 and day 3 - a medium for cultivation of embryos in the pronuclear phase. The second one is applied from day 3 to the blastocyst stage. This medium is most similar to the condition in a woman’s body; thus it reduces the embryo stress in the process of transfer to the uterus. Every day the embryos are assessed for their development and morphology (assessment of division).
Before transfer, the embryos are selected and pictured. The transfer is executed through a special embryo transfer catheter with embryo glue (EmbryoGlue®), which are entered in the uterine cavity under ultrasound control. 


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The primary goal of our team in infertility treatment through IVF is pregnancy achievement. For this, we work hard on maintaining the highest quality of medical care. We make all the efforts to continually improve our knowledge and techniques, which we apply every day. Here is what makes us successful:

• we utilize the latest technologies and clinical methods in infertility treatment
• we use modern and high-tech equipment
• our team is of skilled and experienced professionals
• we maintain strict quality control
• we support continuing education of our reproductive specialists in Bulgaria and abroad
• we provide professional emotional support during the infertility treatment process

Modern techniques for outcome improvement of the IVF/ICSI procedure like IMSI, Spindle View, MACS, Assisted Hatching, Calcium activation, etc., are successfully implemented in the work of Dr. Shterev Hospital. You can read more information about all the techniques in IVF/ICSI in Additional Techniques for IVF section.