title: [ICSI in difficult cases].
abstract: The decision to offer ICSI is based on the quality of the semen, and the presence of severe oligospermia or azoospermia. In the case of severe asthenospermia, a second sample may be requested. In the case of complete asthenospermia, the fertilisation rate can be increased if the ICSI is carried out with spermatozoa selected using HOST (hypoosmotic swelling test). Not all morphological abnormalities have the same repercussions. Certain abnormalities should be excluded, in particular globozoospermia and macrocephalia. Secretory azoospermia may be known about or diagnosed on the first day of treatment, hence the advantage of freezing emergency straws in the event of severe oligoasthenoteratospermia. Meticulous microscopic observation of the ejaculate can allow the identification of occasional and even motile spermatozoa. Female infertility is no longer an indicator for ICSI treatment. In the event of IVF failure with normal sperm, switching to ICSI depends on oocyte quality and maturity. Regarding technical implementation of ICSI, equipment problems are as varied as the equipment is complex. It is conducted outside a sterilizer, thus requiring maintenance of the temperature, pH and sterility. Certain questions remain unanswered. Patients should be informed of the limited chances of success from ICSI, with high instances of aneuploidy and low pregnancy rates.
authors.affiliation: Unité d'AMP/DPI, département de médecine et biologie de la reproduction, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. s-hamamah@chu-montpellier.fr
authors.forename: S
authors.initials: S
authors.lastname: Hamamah
mesh_terms: D053713:Azoospermia / Q000628:therapy; D006801:Humans; D008297:Male; D020554:Sperm Injections, Intracytoplasmic