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Inna - October 9th, 2006 2:19 PM

Dr. Smith
My doctor has recommended going with ICSI because I have only 3 mature follicles and I recall you making a similar recommendation in a previous post. I've read that there is a higher risk of abnormalities when ICSI is used but I couldn't find information on the benefits. In the absence of male factors in infertility, what are the benefits of using ICSI? Why is ICSI recommended when there are few eggs?

I'm 38, 3 ectopics, 2 in the last year, both tubes now removed. Husband is 42 with no issues.

Thank you

Dr Smith - October 10th, 2006 2:55 PM

The use of ICSI when there are only a few eggs is a "feel good" thing. Yes, you may improve fertilization results by poking a sperm in each egg (feel good). However, if an egg doesn't fertilize in the presence of good sperm during a conventional IVF insemination, then there's something wrong with that egg. You can't make a bad egg good by simply putting a sperm inside. The end result is the same. Embryos from bad eggs stop growing, usually between the 4- and 8-cell stage of development. So, its the same either way. A high ICSI fertilization rate looks good on paper and makes everyone feel better. Does it change outcome? No.

Also, since ICSI is a somewhat invasive procedure, some eggs may not survive the injection process. Perhaps these broken eggs would have fertilized just fine using conventional insmeination? Who knows?

Inna - October 11th, 2006 5:12 PM

Thank you for your strait answer.

As an update, we had 4 egs retrieved and 3 fertilezed with icsi. My doctor wants to go with 3 day ET. My new question is about assisted hatching for 3 days embrios(for one spot of endometriose) . Is this commun?
Thanks a lot for your time and the great surce of information when we so need.]

Dr Smith - October 12th, 2006 11:35 AM

The jury is still out on the efficacy of assisted hatching of Day 3 embryos. Some say it improves outcome, some say not. In the end, it is generally agreed that if you are going to perform assisted hatching on Day 3 embryos, the patient populations that would benefit most would be those with a prior IVF failure, those undergoing an FET, patients of advanced maternal age (a euphimism for over 40) and patients that have thick zona pellucidae. I have not heard of endometriosis as an indication for assited hatching (if I read your post correctly), but it cannot hurt and it may help.

Inna - October 27th, 2006 3:27 PM

To share a good news!
We are 14 days after transfer, we had 2 grade A 8-cell and 1 grade B 6-cell embrios, all three in.
And the result is verry positive, beta is 742. We may have multiples.
All the best to you dr Smith!
Good luck!

Dr Smith - November 7th, 2006 12:28 PM

Congratulations! If it is "multiples", I hope its not triplets. Triplet pregnancies are very tricky. Thanks for sharing some good news. We don't see that very often here.

Best of luck.

Inna - November 18th, 2006 5:17 PM

Hi Dr Smith,
We had the U/S and we have One baby developing with 122 bpm at 7weeks 1 day , but the technician was telling us that it is at 6weeks 4 days.
I also have some 2cm bleeding area under the placenta , so I was told to take it easy. We hope that gets reabsorbed soon.
Greetings from us!

Dr Smith - November 20th, 2006 10:28 AM

Cautious optimism. If you take it easy, you will probably be O.K. Good luck. With what you've shared about your placental bleeding, i'm very relieved that you are pregnant with only one fetus.

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