Quick evidence overview
Last updated 13 Jan 26
Live birth
It is unclear whether PICSI affects the chance of having a baby from ICSI
Pregnancy
PICSI doesn’t make a difference to the chance of getting pregnant from ICSI
Miscarriage
PICSI decreases the chance of having a miscarriage from ICSI
What is PICSI for IVF?
PICSI involves selecting sperm for ICSI based on those which bind to hyaluronan
- During an IVF cycle, eggs are combined with sperm either via mixing them in a dish (standard IVF) or injecting one sperm into each egg (ICSI).
- During ICSI, the sperm is normally chosen by the embryologist based on the sperm morphology (shape of the sperm) and its motility (swimming pattern).
- Sperm must be mature, or fully developed, to fertilise an egg and make an embryo. For the majority of patients, most sperm are mature.
- Hyaluronic acid is a substance that naturally surrounds an egg. Mature sperm are known to bind to hyaluronic acid.
- PICSI is a technique used to select sperm based on their ability to bind to hyaluronic acid, which may be a sign that the sperm is mature and capable of fertilising an egg.
PICSI can be performed in two ways
SpermSlow™
SpermSlow™ involves a liquid containing hyaluronic acid, where mature sperm swim more slowly. The slower swimming sperm can then be selected by the embryologist for injection.
PICSI dishes
PICSI dishes have small dots of hyaluronic acid on the bottom. Mature sperm bind to the drops. The embryologist selects one of the bound sperm for injection.
In Australia, only SpermSlow is available (PICSI dishes are not available).
Why might PICSI improve IVF outcomes?
- Selection of mature sperm using PICSI attempts to replicate or mimic the natural sperm selection process.
- Sperm that are selected by PICSI may be more mature or have lower levels of DNA fragmentation.
Why might PICSI not improve IVF outcomes?
- In cases where there are only very few sperm available, PICSI will further reduce the number of sperm available for selection.
- PICSI may not provide any advantage because most or all sperm are usually mature.
- Like many laboratory techniques, the outcome may depend on the technical skills and experience of the embryologist. If the preparation and PICSI procedure are not performed correctly, it could lead to selection of a sperm that is not actually mature or not any more suitable for ICSI than other sperm.
Who might consider using PICSI for IVF?
People who have experienced:
- Male factor infertility
- High sperm DNA fragmentation
- Previous history of poor embryo development
Learn more about common IVF issues and challenges
Does PICSI in IVF work? What the evidence says
PICSI appears to lower the risk of miscarriage in people undergoing ICSI. However, it does not seem to impact the likelihood of achieving pregnancy, and its effect on live birth rates remains unclear. The evidence comes from only two trials, including a large, high-quality study conducted in the UK. While this study is robust and unbiased, its methods may not align with how PICSI is performed or the characteristics of ICSI patients in different settings. As a result, the overall evidence is considered moderate to low quality.
Live birth
It is unclear whether PICSI affects the chance of having a baby from ICSI
Quality of evidence
Only one study is available and the results may not directly apply to all ICSI patients
Pregnancy
PICSI does not make a difference to the chance of getting pregnant from ICSI
Quality of evidence
Only two studies are available and the results may not directly apply to all ICSI patients
Miscarriage
PICSI decreases the chance of having a miscarriage from ICSI
Quality of evidence
Only two studies are available and the results may not directly apply to all ICSI patients
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Trial Reason for exclusion Alegre 2025 Trial has potential trustworthiness concerns Benara 2025 Not randomised Hozyen 2022 Trial not prospectively registered Majumdar 2013 Trial not prospectively registered Troya 2015 Trial not prospectively registered Parmegiani 2010 Some participants took part in the study more than once, therefore the data cannot be used Parmegiani 2012 Compares two types of PICSI - there is no control group
We only include data from randomised controlled trials because these studies provide the most reliable evidence about whether an IVF option is effective and safe. Learn more about our IVF research methods.
Side effects of PICSI
Side effects are not usually relevant for lab-based optional extras like PICSI.
Risks of PICSI and long-term outcomes
It is unknown whether there are any risks or long-term harms from PICSI
- This is based on data from randomised controlled trials and input from IVF specialists. Possible risks of harm and long-term outcomes are often not reported in randomised trials and therefore it is unknown whether PICSI poses any risk of harm to the IVF patient or the embryo/baby.
PICSI has been used in Australia since 2010, and approximately 3,000 IVF cycles have used PICSI.
Cost of PICSI for IVF
PICSI usually costs between $200 - $600 AUD per IVF cycle. This is in addition to the cost of ICSI, which is normally more than the cost of standard IVF.
Cost information is indicative only, costs can vary from clinic to clinic and depending on different circumstances.
Practical considerations about PICSI
- PICSI is a laboratory procedure performed by the embryologist. It does not create any extra procedure or burden on the IVF patient.
- PICSI can be used by the embryologists at the time of ICSI (sperm selection and injection). You can only use PICSI if you are already planning to use ICSI (rather than standard IVF).
Unsure about some of the terms we have used? Use our glossary to understand scientific or unfamiliar terms.
Explore other IVF optional extras
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EmbryoGlue in IVF
Embryo transfer media containing hyaluronic acid
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Acupuncture for IVF
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Preimplantation Genetic Testing for Aneuploidy (PGT-A testing) in IVF
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How to talk to your IVF specialist about this research
Use our guide to help you discuss IVF options with your doctor or IVF specialist. Helping you get the facts to make an informed decision for your IVF treatments.
Disclaimer: Evidence-based IVF is a web-based resource that provides evidence-based information based on research and other data. Content on the Evidence-based IVF webpage is provided for information purposes only and is not intended as a substitute for medical advice. You should consult with qualified and appropriately experienced medical professionals when considering the information from this webpage. Scientific studies and clinical trial results are continually being published. While considerable care has been taken, The University of Melbourne cannot, and does not make any representations and gives no warranties that the information associated with the Evidence-based IVF webpage is in every respect correct, current, complete, reliable, or suitable for any purpose and use is entirely at your own risk.
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