IVF with Intracytoplasmic Sperm Injection (ICSI) is an advanced fertility treatment used to achieve fertilization when natural sperm–egg interaction is unlikely or has previously failed. As part of an IVF cycle, ICSI involves the direct injection of a single, carefully selected sperm into the cytoplasm of a mature egg using a microscopic needle. This technique allows fertilization to occur even in cases of severe male factor infertility or other conditions where conventional IVF may not be effective. Before beginning IVF with ICSI, both partners undergo a thorough fertility evaluation. This includes a specialized assessment of the male factor, such as complete semen analysis, sperm DNA fragmentation testing, and detailed evaluation of sperm morphology and motility. Advanced artificial intelligence (AI) systems analyze these parameters to help embryologists determine the most effective ICSI strategy. On the female side, patients follow a personalized ovarian stimulation protocol designed to maximize egg quality and response. Ovarian development is closely monitored using high-resolution ultrasound and hormonal testing, with protocols continuously optimized using AI-assisted data analysis. Once ovarian stimulation is complete, eggs are retrieved in a minimally invasive procedure performed under conscious sedation. Sperm is collected the same day, either through ejaculation or, when necessary, through specialized techniques such as testicular biopsy in cases where no sperm are present in the ejaculate. In the embryology laboratory, mature eggs are prepared for fertilization. During the ICSI procedure, embryologists—assisted by AI-based sperm selection technology—identify individual sperm cells with the best morphology, motility, and DNA integrity. Each selected sperm is then injected directly into a single egg using state-of-the-art micromanipulation equipment under extreme magnification. This controlled, precision-based approach bypasses many barriers to fertilization and significantly increases the likelihood of successful embryo development. ICSI is commonly recommended for patients with severe male factor infertility (such as low sperm count, poor motility, or abnormal morphology), previous failed fertilization with conventional IVF, the use of surgically retrieved sperm, previously frozen eggs, or when preimplantation genetic testing (PGT) is planned. Compared to conventional IVF—where sperm are placed around the egg and fertilization occurs naturally—ICSI allows embryologists to fully control the fertilization process. Fertilization rates with ICSI are high, typically ranging from 70–80% per injected egg. The procedure is considered safe, with risks similar to those of standard IVF. When performed by certified, experienced embryologists using advanced technology, ICSI is designed to protect both egg and sperm integrity while maximizing the chances of successful fertilization. Following fertilization, embryos are monitored in the laboratory to assess development before being transferred to the uterus or cryopreserved for future use. While ICSI improves fertilization rates, overall pregnancy success still depends on multiple factors, including egg quality, embryo development, uterine health, and individual patient characteristics.