non medically-indicated ICSI

[Anonymous]

My partner and I are considering ICSI because we may be using frozen sperm, and understand the success rates of frozen v. fresh sperm are the same when ICSI is used with frozen. That said, we have no known fertilization issues and his sperm are totally normal. The reason we would be using frozen sperm is because of his travel schedule (long story).

I know very little about ICSI but what I know makes me think it's very likely okay totally fine to use. That said, I am having trouble getting over the fact that it's a) not medically indicated and 2) hasn't been around logn enough for long-term studies to have occured. Plus I don't like the idea of adding an extra layer of things that can go wrong in an already delicate process.

How can I learn more? What thoughts do you have?

[Anonymous]

I'm single and used donor sperm, and my RE used ICSI. It seems to be routine for many practices in this area. I think that doctors like it because rather than adding another layer of things that go wrong, ICSI from their perspective adds another layer of control -- they can ensure that every mature egg meets a sperm, and there's no risk of going back to a patient and explaining that for whatever reason, some egg never fertilized.

There have been some studies of ICSI, though, including a major study in the New England Journal of Medicine that came out few months back that indicated a slightly increased risk of certain birth defects among children conceived using ICSI compared to children who were not conceived using that technique. The question still unansswered is whether the manipulation of ICSI causes the increased risk, or was it because of the underlying fertility issue that made ICSI indicated in the first place.

http://articles.latimes.com/2012/may/05/news/la-heb-fertility-treatment-birth-defects-20120505

http://www.nytimes.com/2012/05/15/health/research/birth-defect-risk-higher-with-fertility-treatments-study-shows.html

This study came out when I was already pregnant, so there wasn't any way for me to "undo" the ICSI. I may have used ICSI even had I known about this study because the risk is increased but still small. Unfortunately, we can only go forward based on the best information that we have. If you feel uncomfortable about it, then don't let yourself be pressured into it, is the best advice I can give.

[Anonymous]

Why don't you try IUI first....then if needed you can do IVF/ICSI.
I am also single/have used donor spermatozoa (IUI & IVF w/ ICSI.)

[Anonymous]

I think it depends on your dx, but as PP asked is there a reason not to pursue IUI first?

If you retrieve enough eggs, you can also do half ICSI and half non-ICSI. That way you still have a high chance that some fertilize but can use any non-ICSI embryos if they make it to transfer.

FWIW, DH and I used ICSI for all because our IF is due to MF (morphology). We're doing a SET today.

[Anonymous]

Thanks- this is really helpful.
To the posters who suggested IUI first, we have female-factor infertility that basically requires IVF (one missing tube; one bum tube).
There's no reason for us to do ICSI except that we hadn't planned on my husband being physically present during this cycle that I just started- until we learned that success rates are less if ICSI isn't performed.
I'm just trying to figure out if it makes sense for us to have him fly back "just" to produce fresh sperm so our success rates aren't compromised and we dont have to use ICSI.
Any other resources are appreciated.

[Anonymous]

OP: in your original post you said "no known fertility issues" so that is why posters such as myself suggested IUI be4 IVF...but then in your last post you said you have tubal problems. I am confused.

[Anonymous]

Anonymous wrote:OP: in your original post you said "no known fertility issues" so that is why posters such as myself suggested IUI be4 IVF...but then in your last post you said you have tubal problems. I am confused.

She said "no known fertilization issues", meaning is his sperm is ok.

OP, given how stressful and expensive IVF cycles are, I would fly your husband back to deliver fresh sperm and maximize the chances, unless he's overseas.

[Anonymous]

Whoops! I'm the original poster.

HE has no known fertility issues (sperm are totally normal); *I* have tubal issues and require IVF to be pregnant.

[Anonymous]

19.23 here

I get it now
Thanks 4 the clarification.

[Anonymous]

I was in your exact boat & so frustrated when I thought I had timed it around dh's busy travel schedule & skipped a cycle that had better timing for me only to have husband be out of town. My RE said if there's no male factor issue, frozen has the same success rates. A benefit is they tested the sample bf freezing it to know it had high numbers vs the risk of performance issues or unknown numbers on the day of. I really wanted to avoid icsi solely bc of the additional cost (nothing was covered for us), and the freezing was an extra $350. I believe my RE said they would proceed w/o & if needed do a rescue icsi, but it wasn't needed. It was successful, & I am 36 wks! Best of luck! Oh I was at CFA.

[Anonymous]

Thanks, 21:17. To be clear, we had been told that the success rates were exactely the same for frozen vs. fresh sperm. So we decided to go ahead with the cycle using frozen sperm. Only when the cycle was underway were we told - almost by accident - that the rates of success were the same IF ICSI was used. Had we known that ICSI was a necessary process in order to have the same rates as fresh sperm, we would not have done a cycle this month but rather waited.

[Anonymous]

She actually said "no known fertilization issues." Clearly if she is doing IVF there are known fertility issues.

[Anonymous]

If the extra (not insubstantial) cost is a factor for you, I would wait to see the number retrieved. If it's large, then even if the fertilization rate is a bit lower for frozen, you will probably still have a few embryos by the transfer date.

[Anonymous]

FWIW, we had unexplained fertility problems and our doctor left it up to us whether to do ICSI and we decided to do it because we decided we'd rather have the greater likelihood of success. (We weren't sure how many cycles of IVF we'd be able to do physically/emotionally/financially.)

[Anonymous]

My husband's morphology was borderline (or slightly below) normal and we also opted for ICSI, just to "cover all bases", as our RE put it. Four out of seven fertilized, three embryos resulted, and I got pregnant.