ICSI is the procedure used to assist the fertilization of the egg by directly injecting the sperm into it. This way we can overcome many problems that have to do with the sperm the egg wall or the way the sperm and the egg interact. All the extra work happens in the lab where the most suitable sperm is selected. We may also use an additional procedure which is called pICSI (Physiological ICSI) to choose the sperm with the highest potential for fertilization. It tests the sperm’s ability to bind to hyaluronan (otherwise known as hyaluronic acid) which is found in the extracellular matrix surrounding ovulating eggs. Hyaluronan-selected sperm has reduced levels of DNA damage and aneuploidy and decreases the rate of early miscarriages.