ICSI or not
3 Replies
justme - February 10

I am pregnant from a successful IVF with ICSI. I had 15 eggs retreived, ICSI, 12 fertilized and only three made it to day 3 and of those only 1 looked good. The other 2 were very poor and fragmented. DH has a fairly low morphology rating. The embryologist didn't know the cause of the problem but was thinking maybe it was a sperm issue.

We will consider IVF again in a year or so. I was curious if you would recommend ICSI again. DH thinks that if we try and let them fertilize on their own (skipping ICSI), that the stronger, better sperm would fertilize the eggs and thus producing more viable embryos. My fear is that if we do that, none will fertilize and it will be a wasted cycle. What is your opinion on this? Have you ever fertilized have with ICSI and let the other half do their own thing???

Thanks in advance for your time.


Dr Smith - February 13

The first thing you need to understand is that the sperm, once inside the egg, does not contribute anything to the first 2.5 days of embryo development. Accordingly, the arrested development and excessive fragmentation you observed was not sperm or ICSI related. It was most likely caused by poor egg quality. Still, there was one good one in the crop, as evidenced by your ongoing pregnancy.

The ability of the sperm to fertilize isassociated with the "strength" of the motility and the morphology. If your husband's morphology score is 4% or below, fertilization (by conventional IVF insemination) will be severely compromised and ICSI is mandated. If the morphology score is above 4% normal forms, conventional IVF insemination is possible depending on the motility characteristics of the sperm on that day.


justme - February 14

Thank you very much for you response. I am curious if the embryologist can tell the quality of the eggs by looking at them. The embryologist seemed to think mine looked great. Can the quality of your eggs be better some months and worse others?


Dr Smith - February 14

You can't tell very much about the developmental potential of the eggs just by looking at them at the time of retrieval. There is no objective grading system for eggs. Reports from the lab that your eggs "look great" can lead to the unrealistic expectation that the resulting embryos will "look great" too. In most cases, the majority of the eggs look viable when retrieved, but the resulting embryos may exhibit slow growth and/or excessive fragmentation (i.e. low grade embryos). Even in young patients, or when donated eggs are used, approximately half of the embryos fail to develop to the point where they are capable of implantation (blastocyst). By and large, this is due to cytoplasmic or genetic abnormalities in the eggs.

There is some cycle-to-cycle variation in egg quality. Every stimulation is different to some degree and each egg is genetically unique. So, a bad crop of eggs on one cycle doesn't mean that the same will occur on the next cycle. However, patients that have a cycle where the majority of the eggs are developmentally incompetent are more likely to have similar results on a subsequent cycle.



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