ICSI, intracytoplasmic sperm injection was developed in 1988 as a treatment for male infertility, i.e., men with very poor sperm parameters, to treat failure of fertilization with IVF. ICSI is now used routinely in many IVF programs as the fertilization rate is higher than with standard fertilization techniques and the pregnancy rates are higher. There is inadequate information about a possible increase in congenital anomalies with ICSI. There appears to be an increased risk of identical twinning with ICSI, especially with transferring blastocysts. This may be as high as 2%.