Should we do ICSI for unexplained infertility?

[Anonymous]

My husband and I have just started our first IVF cycle, and are trying to decide whether or not to do ICSI. We are both 35 and have been trying to conceive for about three years. We have unexplained infertility. All of our test results are really good - sperm numbers are great, no apparent issues with eggs, ovulation, etc. We did expectant management for a while and then tried three IUIs. We have never had a pregnancy.

We do not plan to do genetic testing so we don't need to do ICSI. But our RE suggested we consider it since we have never had a pregnancy, which could mean there is some issue with fertilization. We are unsure what to do. On the one hand, even though we understand the increased risks from ICSI are small, we would still prefer to avoid them if possible. On the other hand, it would suck to go through the full retrieval cycle and end up with few or no viable embryos.

Has anyone been in a similar position? Any advice appreciated.

[Anonymous]

We did ICSI because our issue was with my husband's sperm--they were fine genetically but weren't able to penentrate the egg. ICSI was fairly new then and it worked for us. I don't recall even hearing about possible risks (but it's been 12 years so I've probably just forgotten!) I rececommend it if there is concern about the sperm's ability to get into the egg--but your doctor should be able to tell you if it makes sense in your particular circumstances. Good luck!

[Anonymous]

We have unexplained infertility - though my husband's morphology numbers weren't great they were still definitely workable. Because we'd never had a positive pregnancy test, my doctor thought that there could be something wrong re: fertilization and our IVF cycle pretty much proved it. They retrieved 15 eggs, 14 were mature....but only 7 fertilized the first day. (We had one more fertilize late.) So while only around 50 percent of the mature eggs fertilized (a number less than average), ALL of them made it to day 5 blast and 6 of the 8 were genetically normal. For us, IVF was diagnostic - there was almost certainly something wrong re: fertilization and if we hadn't done ICSI, we may not have had anything fertilize at all.

So...given that the risks of ICSI are pretty small....I'd do it again in a heartbeat.

[Anonymous]

When do you have to decide? We did ICSI because I was a poor responder. RE ended up getting 6 at retrieval, which was actually more than she expected. If you have a small number of eggs at retrieval, ICSI can be helpful because it increases fertilization chances. Maybe you could wait to see how many eggs are retrieved and then maybe the decision?

[Anonymous]

We also had unexplained infertility— not great morphology but good enough. Our doctor offered ICSI and we did it basically because we thought it improved the odds of a successful cycle. Cycles are hard.

[Anonymous]

So we were in a similar situation and told them if we got more than 10 eggs to do a 50/50 split with ICSI and conventional. So that is a possibility. In the end we had a very unexpectedly poor response and so we did ICSI on everything and got a good fertilization rate.

[Anonymous]

Unexplained infertility dx. Great numbers across the board at 27. Did ICSI and had great results. Had 5 blasts with 2 more remaining (1 failed transfer). If I could change anything, I'd have jumped right to it.

[Anonymous]

Yes, I would.

[Anonymous]

Anonymous wrote:So we were in a similar situation and told them if we got more than 10 eggs to do a 50/50 split with ICSI and conventional. So that is a possibility. In the end we had a very unexpectedly poor response and so we did ICSI on everything and got a good fertilization rate.

+1. This is what we did back in 2013 with similar diagnosis. For us, the icsi batch did worse than the conventional batch (go figure). None from our icsi cohort ended up in the top blasts that we either transferred or froze.

[Anonymous]

Not sure what you mean when you say “sperm numbers are great” because sperm “numbers” aren’t the only relevant factor in terms of male side infertility. Motility is a bigger factor. We did ICSI because my husband had low motility. We were successful in our first round of IVF with ICSI.

[Anonymous]

i would do it because my goal is to minimize the number of cycles and optimize our chance each cycle. We are in our first cycle and plan on doing it if needed

[Anonymous]

We did ICSI twice for unexplained and got pregnant both times. Kids are now 13, 13, 10 and totally healthy, smart, etc.

i'm now 45 and never once got pregnant naturally from 30-45 despite actively TTC for much of it and never using protection. All our testing (done several times over the years) was normal but obviously there was something that IVF (and potentially ICSI) overcame because it worked both times we did it.

So i'm a big fan of ICSI for unexplained infertility. in our case i think there was something about my eggs and/or my husbands sperm that didn't allow for spontaneous fertilization. i think this is probably the case in much "unexplained" infertility.