Intracytoplasmic Sperm Injection (ICSI) Male Factor Micromanipulation is a technique in which a single sperm cell is injected directly into the middle of the egg. This enables fertilization to take place even in cases with extremely low sperm counts or very poor sperm quality. If the man has blocked sperm ducts, enough sperm may be retrieved surgically from a very small piece of testicular tissue. This sperm can also be frozen for future ICSI attempts, which avoids repeat testicular biopsy procedures. Males are usually under the care of a reproductive urologist, who works directly with the IVF team. Fertilization rates with ICSI are comparable to in vitro fertilization rates with normal sperm. Pregnancy rates from ICSI are as good, or sometimes better, than other IVF couple's if infertility is due only to poor sperm quality.

Current data from around the world has shown that offspring resulting from IVF or IVF/ICSI have the same rate of birth defects as the general population. However, if the underlying reason for poor sperm production is a male genetic defect, then this defect may be passed on to the offspring. Genetic evaluation and counseling are available, if needed.