What is PICSI?
PICSI (Physiological Intracytoplasmic Sperm Injection) is an additional method of sperm selection as part of ICSI. While in conventional ICSI sperm are selected primarily based on motility and appearance (morphology), PICSI also takes into account their ability to bind to hyaluronic acid.
Hyaluronic acid is a natural component of the environment surrounding the egg cell. A sperm cell’s ability to bind to it develops as it matures and is therefore considered a biological marker of maturity. In PICSI, sperm are placed in a special culture dish containing hyaluronic acid. Sperm that bind to it can then be specifically selected for ICSI.
The method is therefore based on a biological mechanism that also plays a role in natural fertilization. However, this does not mean that PICSI generally leads to better treatment outcomes. Large studies have so far shown no clear advantage over conventional ICSI in terms of pregnancy or live birth rates. There are, however, indications of a lower miscarriage rate; whether certain patient groups benefit in particular has not yet been conclusively clarified.
For this reason, we do not use PICSI routinely, but assess individually whether the additional sperm selection may be appropriate based on your findings and previous treatments.
When is PICSI useful?
PICSI is not routinely recommended for every ICSI treatment. For most patients, no clear advantage over conventional ICSI has yet been demonstrated in terms of pregnancy or live birth rates. However, studies indicate a lower miscarriage rate, and in certain abnormalities of sperm quality, additional sperm selection may be considered on an individual basis.
PICSI may be considered, for example, in cases of:
- Recurrent miscarriages, especially if there are indications of a possible male factor
- Abnormal hyaluronic acid binding capacity of the sperm (HBA test)
- Abnormal embryo development in previous ICSI treatments, when a male factor is being discussed as a possible cause
- Low or absent fertilization rates after previous ICSI treatments
How PICSI treatment works in Munich
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Individual assessment
Before treatment, we review your findings and previous treatment history to determine whether PICSI may be a useful addition to ICSI in your situation.
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Preparation of the semen sample
At the beginning—just as with conventional ICSI—the ejaculate is processed. Motile sperm are isolated from the semen sample and prepared for further treatment.
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Selection with hyaluronic acid
The processed sperm are placed in a special culture dish containing hyaluronic acid. Sperm that bind to it show certain characteristics of sperm maturation and can be specifically considered for further selection.
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Selection for ICSI
From the sperm bound to hyaluronic acid, the embryologist selects a suitable sperm cell. This is then—just as in conventional ICSI—injected directly into the egg cell.
Possible benefits of the PICSI method
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Selection based on a biological marker of maturity
In addition to motility and morphology, PICSI also considers the sperm’s ability to bind to hyaluronic acid. This binding capacity is associated with certain characteristics of sperm maturation.
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Additional sperm selection
Sperm selection is based on a biological mechanism that also plays a role in natural fertilization. This allows for additional differentiation of sperm prior to ICSI.
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Indications of a lower miscarriage rate
A possible clinical benefit of PICSI relates to the miscarriage rate. In the large randomized HABSelect study, fewer miscarriages occurred after PICSI than after conventional ICSI. Systematic reviews also provide indications that PICSI may be associated with a lower miscarriage rate. However, a clear advantage in terms of clinical pregnancy or live birth rates has not yet been demonstrated.
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A useful addition in selected cases
In cases of abnormal sperm quality, or if unexpectedly low fertilization rates or impaired embryo development occurred in previous ICSI treatments, PICSI may be considered as an additional method of sperm selection. We assess individually whether PICSI offers additional benefit in your specific situation.
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Cost of PICSI
PICSI is an additional laboratory service as part of an ICSI treatment. Before treatment begins, you will receive a transparent cost overview so that you know all services and costs in advance.
To the cost overviewThe costs include the additional sperm selection using the PICSI method for the subsequent ICSI.
Make an appointmentNo fixed or flat-rate prices: We bill on the basis of the official scale of fees for doctors (GOÄ). According to the GOÄ, we are not allowed to quote fixed or flat-rate prices for medical services. The prices mentioned are intended to provide orientation and are typical for the treatments mentioned.
Possible VAT liability: Medical services may be subject to VAT (currently 19%). This applies if, after diagnostics have been carried out, no medical indication or confirmed diagnosis is present and it is therefore not a medical treatment in the strict sense. This can be the case in particular with social freezing treatments, but also with the treatment of single moms and same-sex couples.
We would be happy to provide you with detailed cost information for the planned treatment in advance. This allows you to clarify cost coverage with your private health insurance (PKV) as best as possible beforehand. Statutory health insurance (GKV) does not cover costs at our center.
Miller D, et al. Physiological, hyaluronan-selected intracytoplasmic sperm injection for infertility treatment (HABSelect): a parallel, two-group, randomised trial. The Lancet. 2019.
Cochrane Fertility Group. Does the use of advanced sperm selection techniques improve the effectiveness of assisted reproduction for women trying to have a baby? Cochrane Database of Systematic Reviews. 2025.
Frequently asked questions about PICSI
Is PICSI better than conventional ICSI?
No, PICSI is not inherently better than conventional ICSI. PICSI is a specific form of sperm selection within ICSI. PICSI additionally considers the sperm’s ability to bind to hyaluronic acid—a characteristic of biologically mature sperm. No clear advantage has yet been demonstrated for routine use in terms of pregnancy or live birth rates. In certain situations, for example with increased DNA fragmentation, previously poor embryo development, or a history of miscarriages, this additional selection may be considered on an individual basis. Whether PICSI may offer additional benefit in your case will be assessed individually during a personal consultation.
Does PICSI improve the fertilization rate?
A general advantage of PICSI in terms of fertilization rate has not yet been demonstrated. Fertilization depends on numerous factors related to both the egg cell and the sperm. In cases of unexpectedly low fertilization rates in previous ICSI treatments, additional sperm selection may be considered in selected situations; however, whether PICSI actually provides an advantage has not been clearly proven scientifically.
Can PICSI improve embryo quality?
Whether PICSI improves embryo development or embryo quality has not yet been clearly proven. Since an embryo’s development is influenced by both the egg cell and the sperm, a male factor should also be considered in cases of repeatedly abnormal embryo development. In selected situations, PICSI may therefore be considered as an additional method of sperm selection.
Can PICSI reduce the risk of miscarriage?
Yes, studies indicate a lower miscarriage rate after PICSI. In the large randomized HABSelect study, fewer miscarriages occurred after PICSI than after conventional ICSI. Summary analyses of studies also support this possible benefit. One possible explanation is that sperm that bind to hyaluronic acid more often have better DNA integrity. However, a higher live birth rate with PICSI has not yet been clearly demonstrated.
For whom is PICSI not useful?
PICSI is not routinely recommended for every ICSI treatment. In particular, without indications of a relevant male factor or with previously unremarkable ICSI courses, additional benefit has not been demonstrated. Likewise, when the causes of infertility are exclusively female, no advantage is generally expected from the additional sperm selection.
Are there any risks or disadvantages with PICSI?
PICSI primarily changes the selection of sperm prior to the actual ICSI; fertilization then proceeds as in conventional ICSI. This does not create any additional physical burden for the patient. The main disadvantages are the additional costs and the clinical benefit compared with conventional ICSI, which has not yet been clearly demonstrated.
How much does PICSI treatment cost?
The cost of PICSI treatment at our fertility center is approximately €250 per treatment cycle. As a rule, statutory health insurance does not cover the costs. For private health insurance, possible reimbursement depends on the individual plan and the specific medical situation.
What is the difference between PICSI and the HBA test?
The HBA test examines what proportion of motile sperm can bind to hyaluronic acid. PICSI, by contrast, uses this principle directly for sperm selection: for the subsequent ICSI, preference is given to sperm that show binding to hyaluronic acid. An abnormal HBA test can be taken into account in the individual assessment; however, the test is not routinely recommended before every ICSI.
