Each couple individually must consider the decision carefully. The reward is obvious. A pregnancy may be established when it is not possible by any other means. The greatest risk of the ICSI, or for that matter fertility therapy in general, is failure to establish that pregnancy. With ICSI, there is no guarantee of a pregnancy, or for that matter, even fertilization.
Pregnancy rate depends on many factors that are beyond physician, laboratory, and patient control.
A problem in reporting success rates stems from the indication various centers use to perform the ICSI procedure. The success rates will be lower if ICSI is restricted to only the most severe cases of male infertility. Some Centers perform ICSI on a high percentage of patients and a few centers apply this technique to all patients. To date and especially in the United States, ICSI is usually reserved for couples with the clear indications listed in the introduction. Rates after TESA are lower than ICSI and depend on the success of the testicular aspiration as well as the ICSI procedure.