ICSI without MFI?

BankerBSN · January 2014

My RE's protocol is every patient, no matter of diagnosis, gets ICSI. DH is very hesitant to proceed with the ICSI. I was wondering anyone out there that use spontaneous conception for IVF? Or anyone out that did a spilt? And how were the results?

runforcookies · January 2014

I haven't started yet so I have results for you, but we are unexplained so my RE does's half ICSI... So I don't think ICSI w/out MFI is unheard of.

Milagros315 · January 2014

I'm interested to hear these responses too. We don't have MFI, but morphology was borderline so initially I was hoping our RE would recommend ICSI. After he explained the pros and cons of each method, we decided to leave it up to the embryologist.

katekat8721 · January 2014

***siggy****

My RE does ICSI about 75% of the time, not always just for MFI. We used to have MFI before hubby started clomid and moved to the "unexplained" category prior to IVF. We still did 100% ICSI on the whole batch though.

Seeing as we didn't know what our problem really was, we didn't feel comfortable doing 100% non-ICSI. I would hate to have had to go through everything just to find out, oh apparently there's a fertilization problem! Granted, most places can do rescue ICSI the next day (called "fixie"

) but I didn't want to chance that since my RE said it has slightly less success rates. ICSI is not a sure fire way to guarantee fertilization though and every egg may not fertilize. I think we had about 85% even with ICSI.

I've seen some ladies do half ICSI, half non-ICSI to cover both bases and I know some women don't do ICSI at all and end up being just fine! You can ask P/SAIF as well to get ideas too.

Good luck Banker!

mmhopeful · January 2014

We did ICSI as we are "unexplained" and with me being of AMA (advanced maternal age) they thought it would give us the best chance. All 6 eggs fertilized on IVF#1 though they all only made it to the morula stage. 3 were transferred and the other 3 arrested on day 6.

ICSI is out there for other issues too. Hope this helps.

Praying4Miracle17 · January 2014

My old RE did ICSI for everyone regardless (like OP). When discussing with our new RE, he suggested doing half this way and half the other way. With IVF #1, I had 37 eggs, but only 13 mature. The thing with not doing ICSI, it could give the non mature eggs a chance to mature while the sperm is finding the egg. If you do ICSI, if the egg isn't mature, it is automatically discarded after they peel back the layer to inseminate and find out that it's not mature. I think this is what my RE was saying, but I could definitely have some facts wrong.

BankerBSN · January 2014

katekat8721 said:

***siggy****

My RE does ICSI about 75% of the time, not always just for MFI. We used to have MFI before hubby started clomid and moved to the "unexplained" category prior to IVF. We still did 100% ICSI on the whole batch though.

Seeing as we didn't know what our problem really was, we didn't feel comfortable doing 100% non-ICSI. I would hate to have had to go through everything just to find out, oh apparently there's a fertilization problem! Granted, most places can do rescue ICSI the next day (called "fixie" ) but I didn't want to chance that since my RE said it has slightly less success rates. ICSI is not a sure fire way to guarantee fertilization though and every egg may not fertilize. I think we had about 85% even with ICSI.

I've seen some ladies do half ICSI, half non-ICSI to cover both bases and I know some women don't do ICSI at all and end up being just fine! You can ask P/SAIF as well to get ideas too.

Good luck Banker!

This is exactly what I am worried about! I am okay with splitting but I would hate to try all non-ICSI and find that none fertilize. I guess it ultimately depends on how many eggs we are able to retrieve.

Thank you for all your insight ladies

LSN8308 · January 2014

We did a split with all 3 ivfs, even though it was only at the recent SA check for our current cycle we found out dh had slightly low morph (8%) . Our current RE also stressed that the quality of the lab really makes the difference too. Because initially we were hesitant to do icsi again thinking it did nothing for our fertilization rate and esp factoring in that for ivf#2 with a different RE, the batch that had icsi did not fertilize well, compared to the non icsi batch. But we went ahead with the split, and this current cycle our icsi fertilization rate was awesome which if im remembering correctly 10 out of 11 fertilized.

tptbabe · January 2014

I think about half the places we looked into had ICSI included in the pricing for IVF, so it's really becoming more and more commonplace to do it for non-MFI issues.

I'd ask your RE about what they feel the benefits of ICSI over "traditional" IVF, and why they choose to do it for all cycles. Then discuss your thoughts about splitting if you still feel that you would like to do that. (I'd also make a final decision on that after ER so you know how many eggs you're dealing with.) We're considering a split, or even taking one or two and attempting traditional IVF, and we're MFI! Also, we're crazy... there's that too.

FloridaSun82 · January 2014

We didn't make this decision beforehand, it was left up to the embryologist. I had 11 mature eggs and they allowed them to fertilize "naturally." However, only 3 fertilized so they used ICSI for the other 8.

BRaven985 · January 2014

We are unexplained though his count is a little low. They did split and I don't have the exact numbers but there was fertilization for both groups.

RunCC37 · January 2014

We did half ICSI/half traditional IVF with our first round. All mature eggs fertilized. With the second round, we did not do ICSI and out of 9 mature eggs, 5 fertilized. In both cases, we had poor embryo quality (BFN on a Day 3 transfer of two embryos, the remaining arrested at the 4-5 cell stage; second batch all arrested by the 2 cell stage). We are currently getting second opinions for IVF#3. One doctor said definitely yes to ICSI, the other said probably yes. How do we feel about it? We will definitely push for ICSI from this point forward. The way we figure it, why take the chance? We can use all the help we can get, so we're going for it all the way. Good luck, Banker!

Neesey · January 2014

We don't have MFI and we used ICSI. DH actually have fabulous sperm. So much so that two made it into the egg on our last bfp that resulted in a miscarriage. We did it to avoid that issue again.

kz's_girlygirl · January 2014

ICSI is included for all patients at my clinic. We had it done even though we don't have any MFI issues. Out of our 4 mature eggs, 3 did fertilize with ICSI. (only 1 fertilized normally though because of my chromosomal issue). GL whatever you decide- If you are questioning it, definitely talk to your RE before going into things. You can always change your mind during the cycle.

Twinkie0612 · January 2014

ICSI is standard practice at my clinic and I'm glad they do. I'm not a great responder, so with so few eggs I wouldn't want to risk not having any fertilize. Our fert rates aren't fantastic even with ICSI, 3 out of 5 for IVF #1 and 5 out of 7 for IVF #2.

Here's an article from my clinic's website where the RE explains his stance on ICSI for all patients:

https://haveababy.com/ivf-authority/icsi-should-it-be-restricted-to-male-infertility-or-be-a-routine-part-of-all-ivf/

BankerBSN · January 2014

@Twinkie0612 thanks for the link. The research that I have found keeps stating there is an increase of congenital anomalies by 4% with the use of ICSI. But all of the studies can not determine if it is the ICSI its self or the reason why ICSI is being use (which in the past was for sperm issues)

Some days I wish I didn't research everything

vpine · January 2014

My Dr is the same, ICSI for all patients. We personally were okay with it because ICSI makes sure eggs are fertilized and from what I've read, more eggs are fertilized with ICSI than on their own. So there's more fertilized eggs which is good. I had 11 retrieved, 11 fertilized with ICSI, 2 were transferred at 5 days (BFN), rest are frozen, will be doing FET next month.

(sorry, siggy doesn't update)

herecomesthesun · January 2014

Our RE does ICSI for all IVF as well. We didn't have a choice but were happy that it was included because our previous RE had ICSI as an add-on and if you paid for it, it only covered 8 eggs, any more would have been an extra cost.

We ended up with a great fertilization rate with ICSI and high quality blasts. I also read that study with the anomalies and it freaked me out initially. Like you said, there is a possible bias in the study and that could be quite significant in the findings. Besides, I tend to be a worrier and I promised myself that I would relax through this IVF process and have a little faith.

Good luck Banker. I'm really excited for you.

babydreams13 · January 2014

We are unexplained. With IVF 1 we only had 5 mature eggs so I didn't wanna gamble so we opted for ICSI. If I would of had like 10 maybe I wouldn't have done it. All 5 fertilized with ICSI. With IVF 2 we had 14 mature but only 9 fertilize with ICSI. To me I feel like ICSI ups my chances of fertilization so it was worth doing. It was an extra 2500 but if I didn't do it I would be thinking what if I did it. We had 2 to freeze from IVF 2. I am still not pregnant yet but I will do ICSI again for my final IVF.

GL

badrianne · January 2014

Thanks for posting this question. We are in the same situation, considering ICSI without MFI.

I agree with many of the PP and I'll add that my RE also recommends ICSI for endo. Depending on number of eggs retrieved, we'll do ICSI on half.

leavehouse · January 2014

My RE is the same as yours. ICIS FOR ALL!!!

pillowass · January 2014

***siggy****

I wanted to chime in since it seems like my answer is different from most. My RE does not automatically do ICSI, but he does give everyone the option. In our case it was not recommended so we chose "natural" (that term is funny to me considering it all happens in a petri dish!) and we had a very good fertilization rate. We are OOP and ICSI would have cost us an extra $1,500 or something, so that factored in our decision. GL!

beth9409 · January 2014

We did a 50/50 split with our first IVF. The only issue with DH is morphology (0% normal). We did the split because we wanted to know if it was possible for fertilization to occur spontaneously. Our results weren't that great, so on the second IVF we did all ICSI. The thing to remember about letting them fertilize spontaneously is that they don't strip off the outer layer of the egg so you don't know how many are mature.

LSU Tigers · January 2014

My clinic has moved to doing ICSI 100% of the time, regardless if a MFI diagnosis is present.

sandollar1010 · January 2014

This is really interesting. I am new to this and hadn't even considered ICSI since DH has great numbers. It sounds like something we should think about - especially since we are leaning towards PGS, it might even be a requirement.

scooteriste · January 2014

Here's a really informative study from the ASRM that I read recently on the topic. Hope it helps! https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/Intracytoplasmic_sperm.pdf

princessisadora · January 2014

The RE I go to they do ICSI for all IVF, regardless of the issue.

I was going to ask if there is any additional cost to you for the ICSI. The way I see it I would want to take out as many variables out of the equation in order to get the best outcome.

badrianne · January 2014

scooteriste said:

Here's a really informative study from the ASRM that I read recently on the topic. Hope it helps! https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/Intracytoplasmic_sperm.pdf

Thanks for sharing. The ICSI for routine use is an interesting section. Showing no difference...

ksgsmu · January 2014

We are doing ICSI due to our ages and since we are doing PGS testing....

SCSmith2011 · January 2014

I just saw this Banker. You know my history. :-) DH's sperm don't have any issues and we are unexplained IF so as far as we know the only issue is my age. We talked about ICSI with our RE before starting. She said it wasn't required but if we were ok with them using it if need be we could sign the consent forms. It's an additional charge at our RE's office. Basically what they did was watch the eggs to see how they were fertilizing, if it didn't look like it would happen naturally they would use ICSI. All 12 of the mature eggs fertilized on their own so we didn't need it. But we will give them the ok to use it if necessary for our second round of IVF.

ICSI without MFI?

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