ICSI or not?

jschwind22 · November 2012

Hi ladies!

My clinic automatically does 100% ICSI, unless we direct them not to. What are the pros and cons for using ICSI or not? Is there any reason not to? We have MFI, so I'm guessing ICSI is the way to go for us, but I just want to make sure I'm not missing something. TIA!

aprilbeachbride · November 2012

From my research and what our RE has told us, ICSI is usually always done when there is MFI involved. MFI was not an issue for us (we are just "Unexplained") and our RE still recommended it to give us the best possible chance since we don't know what is causing our issues. Our doctor said there are really no drawbacks to doing ICSI (aside from the additional cost). It's totally up to you as the patient, though, you can let the sperm do what they do and let nature take its course, or you can go the ICSI route and let the Embryologist choose the best sperm to implant into the best egg.

Mayzie15 · November 2012

We have severe MFI so we will always use ICSI when doing IVF. If you have MFI, most clinics will suggest you do ICSI - helps your chances during fertilization but usually adds an extra cost. Good luck with your decision!

eandk18 · November 2012

I'm not sure if there are any cons but we are definately doing ICSI. We are unexplained and the doctor said 98% of the time they fertilize on their own and 2% they don't. I know it's only 2% but I don't want to chance it!

brooklynesque · November 2012

If you have MFI I think ICSI is pretty standard. My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding. Apparently there's evidence of a higher rate of birth defects with ICSI.

precious72381 · November 2012

My husband does not have MFI but due to low motility we did ICSI our first round. This cycle we were able to do them naturally. Same amount fertilized for us. The only thing I have read that you may want to ask about is that the little hole they put into the egg gives it a slight advantage to splitting, twins! I don't know the percentage or if it is really an issue, especially if you have MFI and have to do it so it doesn't matter. Both with ICSI and natural my doc put two back so guess he isn't too worried about me having a litter. GL!!!

MrsGlitteryHooks · November 2012

My H doesn't have any sperm issues, the issues were all me. All 6 of my eggs were fertilized with ICSI and we ended up transferring 2 and freezing 3. With it giving you a better chance, I don't see why you wouldn't do it.

jschwind22 · November 2012

brooklynesque:
If you have MFI I think ICSI is pretty standard. My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding. Apparently there's evidence of a higher rate of birth defects with ICSI.

Do you know of any studies regarding this statement about birth defects? The packet that we have to sign acknowledges a slightly higher risk of chromosomal abnormalities leading to miscarriage, but nothing about actual birth defects. Thanks.

BeckyP005 · November 2012

jschwind22:

brooklynesque:
If you have MFI I think ICSI is pretty standard. My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding. Apparently there's evidence of a higher rate of birth defects with ICSI.

Do you know of any studies regarding this statement about birth defects? The packet that we have to sign acknowledges a slightly higher risk of chromosomal abnormalities leading to miscarriage, but nothing about actual birth defects. Thanks.

Wow I didn't know this. Can't remember if the DE coordinator mentioned this as we will be doing ICSI.

violetmarie61516 · November 2012

Like other people said, I've heard there is a slightly higher rate of abnormalities and a higher chance of splitting. I don't have any research to back that up, it's just what I've heard. With out MFI, I would definitely do ICSI.

ball.and.chain · November 2012

jschwind22:

brooklynesque:
If you have MFI I think ICSI is pretty standard. My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding. Apparently there's evidence of a higher rate of birth defects with ICSI.

Do you know of any studies regarding this statement about birth defects? The packet that we have to sign acknowledges a slightly higher risk of chromosomal abnormalities leading to miscarriage, but nothing about actual birth defects. Thanks.

This might be helpful:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424218/

Also, this paper indicates that there is no improvement in clinical outcomes when using ICSI in non-MFI patients:

https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/Intracytoplasmic_sperm.pdf

ETA: MFI isn't an issue for us (we used donor sperm) and we did not do ICSI (our RE was going to do it for us only if the sperm quality was poor after thawing). But since OP has an MFI diagnosis, I do think it sounds like the right thing to do.

faithhopelove01 · November 2012

We had MFI and our RE recommended ISCI right away with IVF, it cost more than just doing IVF it was an additional $1000 for us at our clinic. But from all the research that I did in this area ISCI is what you want to do for MFI and increases your chances since they choose the very best swimmers and put them right into the egg to fertilize!

JSM0801 · November 2012

I just recently had this whole discussion with my dr. We are MFI as well and did ICSI. We had great embryos for the first three days, and then they started slowing down by day five. From what i have gathered, it seems that although ICSI is an amazing process, where the embryologists are choosing the sperm that looks perfect, they might not actually be good sperm. They can only use human eye, but they can't see inside the sperm to know if there are any abnormalities or dna fragmentation. So what often happens in cases of MFI is that they pick sperm that look good and will fertilize the egg, but then they are not healthy enough to continue growing into a good embryo. With natural IVF, it is survival of the fittest, so the best and healthiest sperm will naturally fertilize the egg. However, you are risking the chance of none or very few fertilizing, especially with MFI. There are pros and cons to both, but most likely if you are MFI, your best bet is ICSI. GL

WindyCity33 · November 2012

We're MFI and will be doing ICSI. We're also weighing the pros and cons of assited hatching

Crystal120410 · November 2012

We have no MFI issues, in fact my RE always is impressed with his swimmers. Dh is always a show off even when he's not trying lol. Anywho, there wasnt really a option with us, it's part of our package. Our RE thinks it helps the chances but I guess its really just a matter of opinion. Good luck!!

Scoop77 · November 2012

We decided not to do it, but we're not MFI. They told us at the clinic that there was a slightly higher rate of some birth defects but that they're not sure whether the higher risk comes from the fact that often the couples who are doing ICSI are MFI and naturally have a higher rate of sperm that will cause those birth defects anyway, even if they were naturally fertilizing. They said they're not sure whether it's MFI that causes the increased risk of birth defects or the the ICSI process. We fertilized fine without ICSI, but if we had MFI, I would do it in a heartbeat. GL either way!

diamante1181 · November 2012

If I remember correctly, if its a 2% chance for non-IF, it is like a 3-4% chance for IVF with or without ICSI.

jschwind22 · November 2012

Thank you ladies for your feedback! I think the answer is obvious with the MFI diagnosis- do ICSI. If we didn't have MFI, I would maybe consider doing 1/2 with ICSI and 1/2 without, if there were enough eggs. Good luck everyone!

rrdiva1 · November 2012

jschwind22:
Thank you ladies for your feedback! I think the answer is obvious with the MFI diagnosis- do ICSI. If we didn't have MFI, I would maybe consider doing 1/2 with ICSI and 1/2 without, if there were enough eggs. Good luck everyone!

Hey you, sorry all late to the party! It looks like you made your decision, but yes with MFI ICSI is the way to go! Better chances! ((((hugs))))

new+tothis · November 2012

brooklynesque:
If you have MFI I think ICSI is pretty standard. My clinic (which does academic research on the topic) does not do it unless there's a reason like MFI, however -- at least, that's my understanding. Apparently there's evidence of a higher rate of birth defects with ICSI.

This is what my clinic does too. They recommend doing ICSI for all MFI including antibodies or DNA fragmentation. I think (but I'm not positive) that they recommend it if you've had a previous IVF cycle without success or with low fertilization rates.

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