1 Replies
oct01 - May 31

Dr. Smith,

I'm getting ready for IVF/ICSI in July but have some concerns which procedure to do.

Question 1
In your previous post, you wrote, "Data is now accumulating that ICSI may not be as benign as first thought." Can you provide more details or point me to some articles that expand on this?

Question 2

Female: 31 yrs old, normal tests except 25% ASA

Male: 32 yrs old, DFI 11.9%, HDS 25%, normal semen parameters except morphology 21% and lower sperm concentrations (26 and 33 mil on last 2 SA's with only 9 mil and 8 mil post wash). Had bi-lateral varicocelectomy and left testicular atrophy 10 months ago.

We've had 4 failed IUI's before the surgery and 2 failed IUI's 10 months after the surgery.

First RE said 1/2 ICSI, 1/2 IVF as a form of treatment as well as diagnostic tool (IVF would help determine the fertilization problem).

Second RE said do all ICSI.

Given the above, does this sound like a case for IVF or do we need to move straight to ICSI?


Dr Smith - June 3

Here is the summary of a recent review article exploring the potential downside if ART procedures in general and ICSI specifically.

Assisted reproductive technologies and birth defects
Kohei Shiota and Shigehito Yamada

ABSTRACT In vitro fertilization (IVF) and other assisted reproductive technologies (ART) are effective treatments for infertility and are widely provided at infertility clinics. Although IVF and related ART procedures are generally considered safe, some studies have suggested an excess occurrence of major malformations, low birth-weight and other perinatal complications in babies conceived by ART. Further, it was recently reported that IVF and intracytoplasmic sperm injection (ICSI) are associated with imprinting disorders in the offspring such as Beckwith-Wiedemann syndrome and Angelman syndrome. Here we review the human and animal studies investigating the potential risks of ART, and discuss the need for further investigation.

For further information on each of the potential problems associated woth ART treatment, search the Medline Database (http://www.ncbi.nlm.nih.gov./entrez/query.fcgi) using related kewords (e.g. "ICSI" and "safety". The Medline Database provides summaries of current scientific publications and is a valuable research resource. And its run by the National Library of Medicine, so it FREE!

You have to ask yourselves "Do we want answers, or do we want a baby?" Splitting up the eggs into ICSI and non-ICSI groups could result in halving your chances of pregnancy, if none of the non-ICSI eggs fertilize. You have an answer, but... If you are aware of the potential risks of ICSI and comfortable with them, then I would suggest that you ask for all ICSI to maximize your chances of pregnancy.



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