Physiological ICSI (PICSI)



PICSI is yet another advancement in the field of fertility treatment, albeit one that remains a subject of considerable discussion.


In the ICSI procedure, an individual sperm is selected and injected into an oocyte. Until now, the only technique available to embryologists to select the sperm has always been visual observation. With PICSI, we are able to determine sperm selection in much the same way it happens in human biology.


What does PICSI involve?


PICSI is a method of selecting the best possible sperm for fertilisation in the IVF protocol. The better the quality of sperm, the better the chances of a successful fertilisation during IVF.


PICSI is based on the concept of Hyaluronan binding. Hyaluronan is a material that can be found in most parts of a human body, including the surroundings of a female egg.


What PICSI does is to select sperm according to how well they bind to the Hyaluronan around an egg cell (called hyaluronic acid) through a test called a Hyaluronan Binding Assay.


Sperms are placed in PICSI dish containing samples of Hyaluronan hydrogel. Hyaluronan is a naturally occurring biopolymer found in all human cells, including the gel layer surrounding the oocyte.


Mature, biochemically competent sperm bind to the Hyaluronan where they can be isolated by the embryologist and used for ICSI. This procedure mimics a key step in the natural fertilisation process — the binding of mature sperm to the oocyte complex. As a result, the selected sperm is essentially the same as the one that would be successful in the natural reproductive process.


The research proved that hyaluronan-bound PICSI-selected sperm are, in the vast majority of cases, more mature, exhibit less DNA damage, and have fewer chromosomal aneuploidies.


How does it work?


The process of fertilisation is to screen out weaker sperm and pick the best, so that only the most active sperm with the best genetic material makes it to the egg and fertilises it. The more mature a sperm cell, the more able it is to bind to hyaluronic acid, meaning that it is better suited to fertilising the egg.


PICSI works on the basis that the better sperm are in this respect, the better they are in all other respects, including motility (their ability to move and get to an egg) and morphology (specific shape and structure needed to do a sperm’s job).


PICSI itself is a petri dish which is coated with little segments of Hyaluronan. Sperm are placed in the dish, and those that bind to these Hyaluronan dots are the ones that are chosen for the ICSI procedure, which directly introduces these sperm cells into an egg cell to fertilise it.


For sperm with poor binding capability as measured on the HBA slide, a significant decrease in miscarriage rate may result when the PICSI® dish is used to identify the bound sperm for ICSI.




PICSI is a more refined way of picking the best sperm for fertilisation. While traditionally sperm are selected for ICSI based on their appearance, PICSI selects better sperm based on the sperm’s ability to fertilise and function. Other advantages include:


  • PICSI dishes are convenient and easier to use
  • Lower rates of chromosomal aneuploidies in Hyaluronan-selected sperm
  • Lower rates of DNA damage in Hyaluronan-selected sperm
  • Lower rates of early miscarriage


PICSI increases the success rate by approximately 20% because it enables us to select and introduce a sperm to the oocyte based on its functional quality. This method works on the same principle by which sperms are selected in a woman’s body within the natural fertilisation process.


Who does PICSI help?


  • Patients with high sperm DNA fragmentation.
  • Previous history of poor embryo development day-3 to day-5
  • Previous history of low or poor fertilisation
  • Repeated implantation failure.
  • High miscarriage rate.
  • reduced sperm morphology.
  • reduced sperm motility
  • Low fertilisation with ICSI has occurred
  • The woman is over 38 years old