Physiological Intra-Cytoplasmic Sperm Injection (PICSI)

At Sunfert, we use Physiological Intra-Cytoplasmic Sperm Injection (PICSI) as an advanced extension of ICSI. PICSI allows us to select sperm based on their natural ability to bind to hyaluronic acid ( “HA” is a substance surrounding the egg) to indicate sperm maturity and DNA integrity.

Unlike traditional sperm selection based on appearance and motility alone, we adopt a more physiological approach. This helps us improve the likelihood of selecting the most competent sperm for fertilisation.

PICSI is particularly valuable for couples where previous fertilisation attempts have shown suboptimal results or when sperm quality requires deeper evaluation.

At Sunfert, we may recommend PICSI when we want to enhance sperm selection precision beyond ICSI.

We recommend PICSI for couples who may experience:

• repeated implantation failure
• previous fertilisation challenges
• elevated sperm DNA fragmentation concerns
• abnormal sperm morphology
• unexplained infertility where sperm quality may play a role

From our clinical experience, PICSI can provide additional reassurance when sperm selection needs a more refined approach. 

However, we assess every case individually before recommending this technique as part of a personalised treatment plan.

At Sunfert, we recommend using PICSI for patient’s IVF treatment if:

• previous ICSI cycles did not achieve optimal fertilisation outcomes
• there are concerns about sperm DNA integrity
• patient have experienced recurrent IVF failure
• male fertility parameters show borderline or compromised results

During your fertility assessment, we review both partners’ medical history, hormone profile, ovarian reserve, and semen analysis. Based on these findings, we advise whether PICSI would add value to your treatment cycle.

It can be done in 9 steps.

Step 1: Fertility Evaluation

During a fertility assessment, we conduct a comprehensive evaluation for both partners to identify potential factors affecting fertility and guide a personalised treatment plan.

• Both Spouses: Review of medical history, reproductive history, and previous fertility treatment outcomes.
• Female Spouse: Hormonal profile testing, ovarian reserve assessment, and evaluation of the pelvic organs (uterus, ovaries, cervix, fallopian tubes).
• Male Spouse: Semen analysis to assess sperm quality and reproductive potential.

Step 2: Ovulation Stimulation

Hormonal medications will be given by our doctors which used to stimulate the ovaries to produce multiple eggs.

This stage usually starts at Day 2 or Day 3 of the patient’s menstrual cycle and typically lasts about 10 to 12 days depending on the treatment protocol the patient undergoes.

Step 3: Oocyte Pick-Up (OPU)

Also known as egg retrieval, this is a minimally invasive procedure in which our fertility specialist collects eggs from the patient’s ovaries. The procedure typically takes about 20 to 30 minutes to complete.

During OPU, patients are given light anaesthesia or monitored sedation by an anaesthetist, ensuring that they remain comfortable and pain-free throughout the procedure.

Before concluding the procedure, our fertility specialist will carefully examine the vaginal puncture site to ensure there is no bleeding.

After OPU, patients are observed for 1 to 2 hours in our day ward before being discharged home. 

Most patients experience only mild bloating, cramping, or minimal bleeding, and many are able to return to their normal routine the next day.

Step 4: Hyaluronic Acid Binding

Our embryologists will place the sperm in a hyaluronic acid-coated dish.

Step 5: Microscopic Identification

The matured sperm will bind to the surface of the hyaluronic acid-coated dish, and our embryologists will select the bound sperm for injection.

Step 6: Sperm Injection

Inject the selected sperm carefully into the egg cytoplasm with a specialised microinjection tool.

 

Step 7: Embryo Culture

Fertilised eggs are monitored in our laboratory for 5 to 7 days to develop into viable embryos.

Some patients may choose to undergo Pre-implantation Genetic Testing (PGT), such as PGT-A or PGT-M, to screen their embryos before transfer.

To know why some patients choose to have PGT with their IVF treatment, click the link here to learn more.

• PGT-A (Pre-implantation Genetic Testing for Aneuploidy)
• PGT-M (Pre-implantation Genetic Testing for Monogenic/Single Gene Disorders)

Step 8: Embryo Transfer

The embryo with the highest chance of success, based on quality and development, will be selected for transfer into the patient’s uterus.

Any remaining embryos will be frozen to give the patient another opportunity at attempting pregnancy in the future.

Step 9: Post-Transfer Support

Patients receive guidance and hormone support while awaiting Beta hCG pregnancy testing.

At every stage, Sunfert provides personalised care, clear instructions, and continuous support to ensure comfort and confidence.

If you are facing fertility challenges, start with a consultation with our specialists. We will guide you through your fertility journey with expertise and compassionate care. 

Make an appointment with our Fertility Specialist today and take the next step toward your parenthood goals.

Question #1: Does PICSI improve pregnancy rates?

• PICSI improves sperm selection by choosing more mature sperm, which may enhance fertilisation quality. Outcomes depend on individual fertility factors.

Question #2: Is PICSI suitable for all IVF cycles?

• No. We recommend it based on clinical indicators such as sperm quality, previous IVF outcomes, and medical history.

Question #3: Does PICSI increase treatment cost?

• PICSI is an additional laboratory technique that can help patients with specific fertility challenges. At Sunfert, we recommend it to improve outcomes, not just an added service with extra charge.

Question #4: How do I know if PICSI is right for me?

• PICSI may be recommended to you if there are concerns about sperm quality or if previous IVF/ICSI cycles had poor fertilisation. Your fertility specialist will advise if it may be beneficial based on your test results and treatment history.