ICSI or DIUI
12 Replies
shas - April 30

Hi there

I recently wrote about having 1 embryo (grade1 ) replaced and unfortunately was negative. As our problem is male related, low morphology 1%, count 13 million, motility up to 50% when washed we are wondering because of my poor response are we better to pursure DIUI or use my husbands sperm?

What are chances of success with husbands sperm? My poor response could have been due to a wrong regime for me (I am 34 my fsh was 3.9 a year ago now 8.7. My clinic has said this is still good as 12.5 is high with their tests). However getting night sweats and not sure how long my body will take to get back to normal and whether I want to go through this again. ??? Shas

 

Dr Smith - May 2

If your husband is O.K. with it, I would recommend DIUI. Sounds like your may not have much time left and DIUI will be the most efficient (and least expensive) way to get pregnant.

 

shas - May 3

Dr Smith

Many thanks for your answer, may i ask what do you mean time is running out? Theres seems to be plenty of women who choose IVF and are older than me, does this mean my chances are reduced at my age? I would love to give my husband a second chance at becoming a biological father, but with his sperm so low (1% morphology) is this likely to cause a prblem with the embryo developing.

I have heard that men with low morphology do have problems with their sperm.
We dont want to pay another load of money and put my body through IVF when there may be an even lower chance of success because of his sperm. Can you advise on this please.

Also we have recently read that arginie, co-enzyme q10 and especially pycnogenol are good for increasing mens morphology. is it worth him taking these for 90 days to see if there may be an improvement?

Another question (sorry) is there a chance with IUI using his sperm with the following results from a basic semen analysis (ranges over 3 tests done over 6 months). He has a hydrocele which has been drained hence the 3 tests.

morphology 1% - 5%
motility 12% - 50%
Total effective count 5.5 million to 16 million
volume 2.0 - 2.8 ml

He also had a sperm wash which said sample recovered: 1.6 million motile sperm (3.8 million/ml; 91% motile)

what does this mean?? I'm afraid I am in the teaching profession and trying to make sense of all this.
Hope to hear from you soon. Shas


 

Dr Smith - May 3

A. 1 Time is running out because the developmental potential (genetic normalacy) of the eggs declines rapidly after 35.

A. 2 The low morphology is of considerable concern for me. The is a strong association between abnormal sperm morphology and DNA fragmentation. Excess is DNA fragmentation will reduce the embryo's capacity for continued develoment. This is why I suggested DIUI, if your husband is willing to accept this.

A. 3 Although I never say never, the chances of conceiving through IUI with your husband's sperm is very low (in the range of 5% per attempt).

A4. There have been two studies performed to evaluate the effect of pycnogenol on sperm parameters. Both of these studies involved a very small number of patients and were published in so-so quality "scientific" journals. These were not "beakthrough" studies and I remain skeptical about the efficacy of pycnogenol. Your husband has a long way to go from 1% normal forms to >14% normal forms. That having been said, if you want to try it for a few months (minimum 3), then I don't see any harm in trying. The concentration and % motility will continue to be a problem and, in the end, there may not be an adequate number of strongly motile, morphologically normal sperm to conceive through IUI or timed intercourse.

A5. We begin to see pregnancies from IUI when we inseminate a minimum of 2 million motile sperm (with normal morphology). The chances of pregnancy increase when more and more motile sperm are inseminated. The maximum chances are achieved when 10 million motile sperm are inseminated. More than 10 million doesn't sem to make a difference.

 

shas - May 9

Thanks for answering me we will consider DIUI. It does semm my husbands sperm may not be very good to use even fro ICSI. He does want to attempt ICSI again, but what would you put our chances at with his sperm?

Also what are the chances of me getting pregnant using DIUI? Also have you any advise on what to ask a clinic when using Donor sperm? Shas xx

 

Dr Smith - May 9

I was unable to find your original post, so I don't know how many eggs were retrieved on your last IVF attempt. However, I'd say you'd need at least 6 embryos (not eggs) to have an reasonable chance of success with such a low sperm morphology (<4% normal forms).

The average rate for a stimulated IUI cycle (i.e. with injectable gonadotropins) with donor sperm is about 15% per cycle attempt. Individual clinics may have higher or lower rates. Best if you discuss your chances of DIUI success with your doctor.

Best of luck.

 

stars - May 10

Dr Smith thank you for answering me we are at a crossroads as to what to do.

On our ICSI cycle I produced 1 good egg which resulted in a grade 1 embryo. My clinic only scanned my once (day 11) and think I should have been more closely monitored during stimming. That way my drugs could have been altered and the outcome may have been slightly different. I am 34, my fsh was 3.9 raising to 8 this year. I was told this is quite normal as above 12.5 is high according to my clinics lab. I ovulate (been checked) and have no other known problems.

What I want to know is what are the chances of ICSI working using my husbands sperm (considering low morphology)?? I do worry also because another factor is I may be one of those people who dont respond very well to drugs and possibly only produce a few eggs next time. ???

If we go down the DIUI route would a natural cycle DIUI be better for me as opposed to one with drugs? ???

 

Dr Smith - May 10

If you are only producing one egg on a stimulated cycle, I don't think IVF/ICSI is appropriate. Taking more medications will not increase the number of follicles developing on a given cycle. However, if more than one follicle develops, closer monitoring of the stimulation phase may result in more eggs being retrieved. Discuss this with your doctor.

If you produce more than one egg on a stimulated cycle, then the success rate for DIUI is higher on a stimulated cycle (more eggs, more embryos, more chances of success). If you are only producing one follicle on a stimulated cycle, and you ovulate on your natural cycles, what's the point in taking the medication? It won't increase your chances.

 

stars - May 10

Many thanks dr Smith for your valued opinions, you have explained a lot particularly about our chances with low morphology and possible routes to go. Shas

 

shas - August 18

[quote author=shas link=board=6;threadid=808;start=0#5457 date=1115113536]
Dr Smith


[/quote]

 

shas - August 18

[quote author=shas link=board=6;threadid=808;start=0#5292 date=1114821278]
Hi there

I recently wrote about having 1 embryo (grade1 ) replaced and unfortunately was negative. As our problem is male related, low morphology 1%, count 13 million, motility up to 50% when washed we are wondering because of my poor response are we better to pursure DIUI or use my husbands sperm?

What are chances of success with husbands sperm? My poor response could have been due to a wrong regime for me (I am 34 my fsh was 3.9 a year ago now 8.7. My clinic has said this is still good as 12.5 is high with their tests). However getting night sweats and not sure how long my body will take to get back to normal and whether I want to go through this again. ??? Shas
[/quote]

 

shas - August 18

[quote author=shas link=board=6;threadid=808;start=0#5292 date=1114821278]
Hi there

[/quote]

 

Dr Smith - August 19

Your chance of success will depend on the quality of the sperm used for insemination and the quantity/quality of the eggs. Based on the information you've given, I think donor sperm would be the better option. However, the ovarian stimulation needs to be improved so that more than one follicle/egg develops per cycle. Otherwise, you are wasting money on medications that are getting you no farther ahead than a natural cycle.

 

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