Male Infertility and ICSI: How Often US Clinics Use It

Male factors are involved in a large share of infertility, and one IVF technique, intracytoplasmic sperm injection (ICSI), is commonly used to treat it. Today ICSI is used in most US IVF transfers, including many where no male factor was diagnosed. This guide explains the causes of male infertility, what ICSI is, and how widely US clinics use it. It is general information, not medical advice.

How common is male infertility?

NICHD reports that men are the only cause or a contributing cause of infertility in about 40% of couples’ cases.^[3] In US IVF data, male factor was recorded as a reason for treatment in 28% of cases in 2022, the most common infertility diagnosis in the data. More than one reason can be recorded.^[1] The CDC defines male factor infertility as any cause of infertility due to low sperm count or problems with sperm function that makes it difficult for a sperm to fertilize an egg under normal conditions.^[2]

Common causes

According to NICHD:^[3]

• The most common issues affect how the testicles work. Others involve hormone imbalances or blocked or missing ducts.
• A complete lack of sperm (azoospermia) is the cause in about 15% of infertile men.^[3]
• A low sperm count is called oligospermia; its most common cause is varicocele, an enlarged vein in the scrotum, present in about 40% of men with fertility problems.^[3]
• Problems transporting sperm, including blockages, vasectomy and retrograde ejaculation, cause about 10% to 20% of male infertility cases.^[3]

Lifestyle, environmental and age-related factors also play a role.^[3] See causes of infertility in women and men.

Treatments other than IVF

NICHD says medication can treat some issues that affect male fertility, such as hormone imbalances and erectile dysfunction, and surgery can repair blockages in the tubes that carry sperm.^[4] Surgery can also repair a varicocele; NICHD notes current research suggests it can improve sperm health but has not affected the chances of conception.^[4] If surgery does not restore fertility, ART can be effective.^[4]

Intrauterine insemination (IUI) is another option. NICHD lists low sperm count, low sperm mobility, erection problems and retrograde ejaculation among the situations where IUI is most effective.^[6] See IUI vs. IVF.

What is ICSI?

The CDC defines ICSI as a procedure where a single sperm is injected directly into an egg, and notes that it is commonly used to treat male infertility.^[2] In standard IVF, sperm and eggs are placed together and fertilization happens on its own. MedlinePlus explains that if the chance of fertilization is low, the sperm may be injected directly into the egg, and that many programs routinely do ICSI on some of the eggs even when things appear normal.^[5]

How often US clinics use ICSI

In 2022, 77.7% of US embryo transfers included at least one embryo created with ICSI (compared with 77.9% in 2021).^[1][7] That is far higher than the share of cases with a male factor diagnosis (28%), which shows that ICSI is widely used beyond male infertility.^[1]

Age group	Transfers with an ICSI embryo (2022)
Under 35	82.0%
35–37	79.8%
38–40	77.6%
Over 40	66.7%

ICSI use varies widely by clinic

Practice differs a lot between clinics. Across US clinics reporting the measure, the median clinic used ICSI in 82.8% of transfers. The middle half of clinics ranged from 69.9% to 90.8%.^[1] Every clinic profile on FertilityList shows its own share compared with the national figure.

By state

States with at least five reporting clinics, ranked by the median clinic’s ICSI share:^[1]

State	Clinics	Median ICSI share
Hawaii	5	91.7%
Minnesota	5	90.2%
Alabama	5	88.8%
Missouri	9	88.4%
Nevada	6	88.1%
Georgia	10	87.3%
North Carolina	11	86.2%
California	79	86.0%
Illinois	19	85.4%
Texas	44	84.8%

A higher or lower ICSI share is not a measure of quality. It reflects patient mix and clinic practice.^[1]

Where ICSI fits in an IVF cycle

MedlinePlus describes the sequence. After egg retrieval, sperm is normally placed together with the best-quality eggs, and fertilization usually happens a few hours later. When the provider thinks the chance of fertilization is low, a single sperm is injected into each mature egg instead. The fertilized eggs are then grown in the lab for about five days before an embryo is transferred or frozen.^[5] ICSI changes only the fertilization step; stimulation, retrieval and transfer stay the same.

What the data cannot tell you

The CDC reports how often transfers involve an ICSI embryo, but not why ICSI was used for each patient, and it does not publish clinic success rates separately for ICSI and conventional fertilization.^[1] A clinic’s ICSI share therefore says something about its routine practice, not about whether ICSI helped. Clinic outcomes are best compared using the measures in how to read IVF success rates.

Questions to ask a clinic

• What did the semen analysis show, and is ICSI recommended for that reason or as routine practice?
• Does ICSI add to the cost of the cycle?
• If no sperm are found in the ejaculate, what options does the clinic offer?
• Would treating an underlying condition first change the plan?

Related guides

• What is infertility?
• Fertility testing: what to expect
• How to read IVF success rates