To ICSI or not to ICSI? Help...
1 Replies
Laura46 - August 7

Ok. My hubby has had 4 SA's done in the last year. The first 3 were perfectly normal and pretty consistent. His morphology was around 31-33% normal forms, motility ranged from 50-55% and count was always above 80 million per ml. However, the last SA (1 week ago)showed a drop in morphology to 7%. There is no time to retest because our donor egg retrieval is tomorrow. The clinic is (of course) recommending ICSI, which we would rather not do because of unknown long term effects on the resulting children. The clinic has also said they do not repeat the morphology test on the day of retrieval because it takes too much of the sample. That makes it very difficult for us to make an informed decision. My questions are: What could have caused such a drastic change in such a short time? He hasn't been ill, doesn't drink or smoke. He did spend a lot of time working outdoors and driving a car with no A/C in 100+ degree temperatures the last two weeks. Could that be the cause? Sorry if this is too much information, but we made sure that he has had an ejaculation every day since then (out with the old, in with the new)....
What should we do? Do ICSI when we are afraid of the risks, or risk poor fertilization if the problem hasn't corrected itself yet? Thanks for your help!


Dr Smith - August 8

One explanation is that the lab used a different morphology criteria. The first 3 tests used the WHO sperm morphology criteria. The most recent used "strict" criteria. If that does not explain it, it may be related to heat stress, or just a "bad sperm" day. There is significant day-to-day variation in semen parameters (albiet, usually not this dramatic).

There have been some reports in the past suggesting that ICSI may be associated with congeneital abnormalities, but these appear to be isolated events. ICSI continues to be used extensively in IVF programs and ongoing studies have shown there's no higher incidence of problems (congenetial or developmental) in ICSI children. The benefits of performing ICSI (when needed) outweigh any potential problems. The question of when its needed will vary from program to program. Some programs use any excuse or routine perform ICSI on every patient to prevent even the smallest chance of failed fertilization.

It takes no more than 1 drop of semen to make a morphology slide, so the excuse that it takes too much of the sample is B.S. It does however, take extra time to stain and read the morphology slide. I think that's why they don't want to do it.



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