**17. Options for patients after repeated ICSI cycle failure**

Physicians should counsel patients based on the best possible evidence available and allow the couple to make an informed choice. The adverse result of a failed ICSI cycle does not imply a hopeless prognosis for future ICSI treatment. Very subtle improvements in semen parameters and/or oocyte yield/quality may result in fertilization in a subsequent ICSI attempt [169]. Otherwise, the options of donor sperm insemination, donated oocytes or embryos, adoption and remaining childless should be discussed with the couple [171].
