ICSI was first used at UCSF in 1994 and today it has expanded to encompass almost all cases of male infertility. Intra Cytoplasmic Sperm Injection - ICSI is a micromanipulation technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous IVF (In Vitro Fertilization) attempt. The procedure overcomes many of the barriers to fertilization and allows couples with little hope of achieving successful pregnancy to obtain fertilized embryos. This procedure is done using an inverted microscope equipped with micro-manipulators & micro-injectors where the prepared sperm is injected using a microinjecting pipette. ICSI has a fertilization rate of 90%. ICSI is accompanied by PESA (Percutaneous Epidydimal Sperm Aspiration) or TESA (Testicular Sperm Aspiration) that are procedures performed to obtain sperm in certain cases of male infertility. They can be performed on men with ultra low sperm counts due to either a sperm production problem or blockage in reproductive tract as the result of a vasectomy, congenital absence of vas deferens, or infection.